What Sets Physically Active Rural Communities Apart from Less Active Ones? A Comparative Case Study of Three US Counties.

BACKGROUND: Rural US communities experience health disparities, including a lower prevalence of physical activity (PA). However, "Positive Deviants"-rural communities with greater PA than their peers-exist. The purpose of this study was to identify the factors that help create physically active rural US communities. METHODS: Stakeholder interviews, on-site intercept interviews, and in-person observations were used to form a comparative case study of two rural counties with high PA prevalence (HPAs) and one with low PA prevalence (LPA) from a southern US state, selected based on rurality and adult PA prevalence. Interview transcripts were inductively coded by three readers, resulting in a thematic structure that aligned with a Community Capital Framework, which was then used for deductive coding and analysis. RESULTS: Fifteen stakeholder interviews, nine intercept interviews, and on-site observations were conducted. Human and Organizational Capital differed between the HPAs and LPA, manifesting as Social, Built, Financial, and Political Capital differences and a possible "spiraling-up" or cyclical effect through increasing PA and health (Human Capital), highlighting a potential causal model for future study. CONCLUSIONS: Multi-organizational PA coalitions may hold promise for rural PA by directly influencing Human and Organizational Capital in the short term and the other forms of capital in the long term.

Associations between objective physical activity and emotional eating among adiposity-discordant siblings using ecological momentary assessment and accelerometers.

BACKGROUND: Emotional eating is associated with obesity, though less is known regarding factors that predict emotional eating episodes in children and adolescents. OBJECTIVES: To investigate whether moderate to vigorous physical activity (MVPA) or total activity counts 60 minutes prior to psychological stress predicted stress-related eating and positive emotional eating (ie, eating while happy), and whether adiposity (z-BMI) moderated these associations. METHODS: Participants were drawn from a prior study of siblings (N = 77; mean age = 15.4 ± 1.4 years) discordant for weight status (39 non-overweight siblings, 38 siblings with overweight/obesity) who completed an ecological momentary assessment protocol with accelerometer-based assessment of physical activity. RESULTS: Greater MVPA was associated with lower stress-related eating across the sample. Lower total activity (between-person effects) and lower MVPA (within-person effects) were associated with greater stress-related eating for siblings with greater z-BMI. Greater total activity was associated with lower positive emotional eating for siblings with lower z-BMI (between- and within-person). CONCLUSIONS: Findings demonstrate potential regulating effects of prior physical activity on emotional eating at the individual and momentary level, though there are nuances depending on z-BMI. Future work is needed to examine underlying mechanisms and timescale of effects, and particularly the extent to which enhancing MVPA time among youth with z-BMI may mitigate momentary risk of stress-related eating episodes.

Youth and Adult Visitation and Physical Activity Intensity at Rural and Urban Parks.

Less physical activity among rural residents may contribute to rural-urban health disparities. Parks can be ideal community resources for promoting physical activity. This study compared park visitation and activity intensity at 15 urban and 15 rural parks matched for acreage and amenities. Parks were observed in the morning, afternoon, and evening on 4 days to determine number of visitors, activity intensity, and amenity use. A total of 5486 visitors were observed with no differences in percentages of males (55.5% vs. 53.9%) and females (44.5% vs. 46.1%) or percentages of weekday (82.4% vs. 81.9%) and weekend (17.6% vs. 18.1%) visitors. The probability of visitors sitting was greater and in moderate intensity activity lower at rural parks. A greater proportion of children (25.0% vs. 14.5%) in rural parks, and teens in urban parks (8.0% vs. 69.6%), were observed on sport fields. A greater proportion of adults in urban areas (12.5% vs. 46.0%) were observed spectating sports. Greater proportions of rural children (10.9% vs. 3.5%), teens (34.1% vs. 12.4%), and adults (38.9% vs. 10.1%) were observed using shelters. Thus, when similar amenities are available, rural and urban parks are used differently, especially by youth. The urban park study results cannot be wholly applied to rural parks.

Study design for a clinical trial to examine food price elasticity among participants in federal food assistance programs: A laboratory-based grocery store study.

We present a protocol for a study investigating the effect of food price changes on purchasing decisions among individuals participating in federal food assistance programs and among those not participating in these programs. We use a laboratory-based grocery store design, which provides greater control over factors influencing food purchasing than in situ experiments in actual grocery stores. We focus primarily, but not exclusively, on eggs because they are highly nutritious, easy to prepare, can be included in many different dishes, and are a part of a wide range of cultural food menus. The primary aim of this study is to compare the own-and cross-price elasticity of eggs between individuals participating in federal food assistance programs and those not participating in these programs. Our secondary aims are to 1) compare the own- and cross-price elasticity of eggs between overweight/obese individuals and non-overweight/obese individuals, 2) examine whether delay discounting moderates the effect of income on own- and cross-price elasticity, 3) examine whether subjective social status moderates the effect of participation in federal food assistance programs on the purchase of high nutrient-dense foods, and 4) examine whether usual psychological stress level moderates the effect of subjective social status on the purchase of high-nutrient dense foods. The results of this study will provide information about the drivers of food demand among low-income adults. A better understanding of these drivers is needed to develop effective nutrition interventions for this large population.

Nutrient intake disparities in the US: modeling the effect of food substitutions.

BACKGROUND: Diet quality among federal food assistance program participants remains low, and little research has assessed the diet quality of food insecure non-participants. Further research is needed to assess the extent to which food substitutions can improve the nutritional status of these vulnerable populations. Substituting egg dishes for other commonly consumed dishes at certain eating occasions may be an effective strategy for improving the daily nutrient intake among these groups. Eggs are rich in many important nutrients, and are low-cost and part of a wide range of cultural food menus, which are important considerations for low-income and ethnically diverse populations. To help guide the focus of targeted nutrition interventions and education campaigns for vulnerable populations, the present work begins by 1) estimating the prevalence of nutrient inadequacy among these groups, and then models the effect of consuming egg dishes instead of commonly consumed dishes at each eating occasion on 2) the prevalence of nutrient inadequacy, and 3) the mean intake of nutrients. METHODS: Dietary data from 34,741 adults ≥ 20 y were acquired from the National Health and Nutrition Examination Survey, 2001-2014. Diet pattern modeling was used to substitute commonly consumed egg dishes for commonly consumed main dishes at breakfast, lunch, and dinner. National Cancer Institute usual intake methods were used to estimate the prevalence of inadequate intake of 31 nutrients pre- and post-substitution, and a novel index was used to estimate change in intake of all nutrients collectively. RESULTS: Substituting eggs for commonly consumed main dishes at lunch or dinner did not change total daily nutrient intake for each group (P > 0.05), but decreased the prevalence of vitamin D inadequacy by 1-4 percentage points (P < 0.01). Substituting eggs for commonly consumed foods at breakfast increased the prevalence of folate inadequacy by 8-12 percentage points among each group (P < 0.01). CONCLUSIONS: When making food substitutions to increase nutrient intake, eating occasion should be an important consideration. Further research is needed to better understand how food substitutions affect diet costs, which may be an important driver of food purchasing decisions among low income individuals with limited food budgets.

Cost-effectiveness of Family-Based Obesity Treatment.

BACKGROUND AND OBJECTIVES: We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. We reported greater reductions in child and parent weight at 6 and 24 months compared with an attention-controlled information control (IC) group. This article reports the cost-effectiveness of long-term weight change for FBT compared with IC. METHODS: Ninety-six children 2 to 5 years of age with overweight or obesity and with parents who had a BMI ≥25 were randomly assigned to FBT or IC, and both received diet and activity education (12-month treatment and 12-month follow-up). Weight loss and cost-effectiveness were assessed at 24 months. Intention-to-treat, completers, and sensitivity analyses were performed. RESULTS: The average societal cost per family was $1629 for the FBT and $886 for the IC groups at 24 months. At 24 months, child percent over BMI (%OBMI) change decreased by 2.0 U in the FBT group versus an increase of 4.4 U in the IC group. Parents lost 6.0 vs 0.2 kg at 24 months in the FBT and IC groups, respectively. The incremental cost-effectiveness ratios (ICERs) for children and parents' %OBMI were $116.1 and $83.5 per U of %OBMI, respectively. Parental ICERs were also calculated for body weight and BMI and were $128.1 per 1, and $353.8/ per kilogram, respectively. ICER values for child %OBMI were similar in the intention-to-treat group ($116.1/1 U decrease) compared with completers ($114.3). CONCLUSIONS: For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group.

Time Trends and Patterns of Reported Egg Consumption in the U.S. by Sociodemographic Characteristics.

Eggs have the potential to contribute essential nutrients to nutritionally vulnerable populations on limited food budgets. Further research is needed to better understand patterns of egg consumption across diverse sociodemographic groups in order to inform clinical practice to improve nutrient adequacy. Data on demographics and egg intake of 29,694 U.S. adults were obtained from the National Health and Nutrition Examination Survey, 2001-2012. The National Cancer Institute's usual intake methodology was used to estimate the distribution of egg intake. Linear and logistic regression models were used to test for time trends in egg consumption and for differences between sociodemographic groups. The proportion of the U.S. population, overall (21%-22%; p = 0.311) and by sociodemographic group (p > 0.05 for all groups), that reported consuming eggs remained unchanged from 2001 to 2012. Mean egg consumption increased overall from 23.0 (95% CI, 20.8-25.2) g/day in 2001-2002 to 25.5 (22.7-28.4) g/day in 2011-2012 (p = 0.012), but not among food insecure individuals (p = 0.816) and Supplemental Nutrition Assistance Program (SNAP) participants (p = 0.399). No differences in the odds of egg consumption were observed by income level, food security status, or SNAP participation status (p > 0.05 for all groups). Given the nutritional benefits of eggs, as well as their low cost and culinary versatility, the results presented here have important implications for reducing disparities in health outcomes and diet quality, in particular among food insecure individuals and SNAP participants. Further research is needed to examine factors that influence egg consumption and associated nutrient intake, and to identify potential barriers to increasing egg consumption, such as egg price changes, across diverse sociodemographic groups.

Aerobic and resistance exercise reinforcement and discomfort tolerance predict meeting activity guidelines.

BACKGROUND: Understanding individual-differences of those people who do and do not meet physical activity recommendations could inform targets for increasing physical activity. Exercise reinforcement may be one such individual-level determinate, but it is not yet known whether those who meet activity guidelines have a greater relative reinforcing value (RRV) of aerobic exercise training (RRVAT) or resistance training (RRVRT). The predictors of RRVAT or RRVRT are also not yet known. PURPOSE: To determine whether individuals who meet aerobic activity or muscle strengthening activity guidelines have greater RRVAT or RRVRT and whether the preference and tolerance for exercise intensity predicts RRVAT or RRVRT. METHODS: Men (n=38) and women (n=50) were measured for RRVAT, RRVRT, minutes of vigorous physical activity, usual resistance training behavior, and completed the Preference for and Tolerance of the Intensity of Exercise Questionnaire. RESULTS: Individuals who met physical activity guidelines for aerobic activity and muscle strengthening activity had 58% greater RRVAT and 54% greater RRVRT, respectively, than those who did not meet these guidelines. Preference and tolerance for exercise intensity was associated (p<0.01) with greater RRVRT, but not RRVAT. CONCLUSION: Having greater RRV of a mode of exercise is associated with meeting activity guidelines for that mode of exercise. Discomfort tolerance during exercise is associated with greater RRV of resistance exercise.

Height-Adjustable Desks: Energy Expenditure, Liking, and Preference of Sitting and Standing.

BACKGROUND: Breaking periods of sitting with standing may prevent chronic diseases and increase energy expenditure (EE). Sit-to-stand height adjustable desks may promote workplace standing, but workers have to be willing to stand for portions of the workday. METHODS: For studies 1 and 2, EE was measured during word processing while sitting in a chair and while standing. Subjects scored their liking of each posture and time they would be willing to work in each posture during an 8-hour workday. Study 2 included an intervention of replacing subjects' sitting desks with a height adjustable desk. Liking of and willingness to work in each posture were measured before and after the 12-month intervention. RESULTS: EE was 7.5 kcal/h greater when standing than when sitting. Subjects liked sitting more than standing in study 1. In study 2, liking of postures did not differ or change across 12 months use of height adjustable desks. Perceived willingness to stand decreased from 4.5 h/d at baseline to 3.4 h/d after 12 months. CONCLUSIONS: Standing rather than sitting increased EE by 7.5 kcal/h. Use of a height adjustable desk for 12 months did not alter the hedonic value of standing or sitting, which is promising for long-term increases in standing.

What constitutes food variety? Stimulus specificity of food.

Variety is a major influence of energy intake, but it is not known how much foods have to vary to influence eating. Using a stimulus specificity habituation paradigm we assessed the influence of varying the texture and appearance of nutritionally identical foods on responding for food and energy intake, and whether sensitization, or an increase in responding prior to habituation, was related to the rate of habituation or recovery of responding. Children responded for elbow macaroni and cheese until they habituated, then were provided either more elbow macaroni and cheese, spiral macaroni and cheese, or chicken nuggets. Children provided chicken nuggets or spiral macaroni and cheese recovered responding in comparison to more elbow macaroni and cheese. Children who sensitized showed slower habituation and consumed more food and more energy than those who did not sensitize, but did not differ in recovery of responding to the chicken nuggets or spiral macaroni and cheese. Results show small variations in food characteristics lead to recovery of responding and increased intake after children have habituated.

Increasing passive energy expenditure during clerical work.

Sitting on a therapy ball or standing may be a passive means of increasing energy expenditure throughout the workday. The purpose of this study was to determine the energy expenditure and liking of performing clerical work in various postures. Subjects included 24 men and women employed in sedentary clerical occupations. Energy expenditure was measured while word processing in three standardized postures; sitting in an office chair, sitting on a therapy ball, and standing. Adults ranked their comfort, fatigue, and liking of each posture and were asked to perform their choice of 20 min of additional clerical work in one of the postures. Energy expenditure was 4.1 kcal/h greater (p or= 0.48). Subjects also liked sitting on a therapy ball as much as sitting in an office chair and liked sitting on a therapy ball more than standing (p

Price and maternal obesity influence purchasing of low- and high-energy-dense foods.

BACKGROUND: Price can influence food purchases, which can influence consumption. Limited laboratory research has assessed the effect of price changes on food purchases, and no research on individual differences that may interact with price to influence purchases exists. OBJECTIVE: We aimed to assess the influence of price changes of low-energy-density (LED) and high-energy-density (HED) foods on mother's food purchases in a laboratory food-purchasing analogue. DESIGN: Mothers were randomly assigned to price conditions in which the price of either LED or HED foods was manipulated from 75% to 125% of the reference purchase price, whereas the price of the alternative foods was kept at the reference value. Mothers completed purchases for 2 income levels ($15 or $30 per family member). RESULTS: Purchases were reduced when prices of LED (P < 0.01) and HED (P < 0.001) foods were increased. Maternal BMI interacted with price to influence purchases of HED foods when the price of HED foods increased (P = 0.016) and interacted with price to influence purchases of LED foods when the price of HED foods increased (P = 0.008). CONCLUSION: These results show the relevance of considering price change as a way to influence food purchases of LED compared with HED foods and the possibility that individual differences may influence the own-price elasticity of HED foods and substitution of LED for HED foods.

Cost effectiveness of recruitment methods in an obesity prevention trial for young children.

BACKGROUND: Recruitment of participants for clinical trials requires considerable effort and cost. There is no research on the cost effectiveness of recruitment methods for an obesity prevention trial of young children. METHODS: This study determined the cost effectiveness of recruiting 70 families with a child aged 4 to 7 (5.9+/-1.3) years in Western New York from February 2003 to November 2004, for a 2-year randomized obesity prevention trial to reduce television watching in the home. RESULTS: Of the 70 randomized families, 65.7% (n=46) were obtained through direct mailings, 24.3% (n=17) were acquired through newspaper advertisements, 7.1% (n=5) from other sources (e.g., word of mouth), and 2.9% (n=2) through posters and brochures. Costs of each recruitment method were computed by adding the cost of materials, staff time, and media expenses. Cost effectiveness (money spent per randomized participant) was US $0 for other sources, US $227.76 for direct mailing, US $546.95 for newspaper ads, and US $3,020.84 for posters and brochures. CONCLUSION: Of the methods with associated costs, direct mailing was the most cost effective in recruiting families with young children, which supports the growing literature of the effectiveness of direct mailing.

The neighborhood and home environments: disparate relationships with physical activity and sedentary behaviors in youth.

BACKGROUND: To increase participation in physical activity, it is important to understand the factors associated with a child's choice to be physically active or sedentary. The neighborhood and home environments may be related to this choice. PURPOSE: To determine whether the neighborhood environment or number of televisions in the home environment are independently associated with child physical activity and television time. METHODS: The associations of the neighborhood and home environments on active and sedentary behaviors were studied in 44 boys and 44 girls who wore accelerometers and recorded their television watching behaviors. Neighborhood environment variables were measured using extensive geographic information systems analysis. RESULTS: Hierarchical regression analyses were used to predict physical activity after controlling for individual differences in age, socioeconomic status, percentage overweight, and time the accelerometer was worn in Step 1. Sex of the child was added in Step 2. A neighborhood design variable, street connectivity, accounted for an additional 6% (p

Association of access to parks and recreational facilities with the physical activity of young children.

OBJECTIVE: To determine associations of the neighborhood and home television environments with young children's physical activity. METHOD: 32 boys and 27 girls age 4 to 7 years wore accelerometers for 3 weekdays and 1 weekend day. The number of televisions in the home and television watching of the child were monitored using TV Allowance units for 3 weeks. A geographic information system was used to measure neighborhood environment variables. RESULTS: Hierarchical regression analysis was used to predict physical activity, initially controlling for sex, age, socioeconomic status, adiposity, and child television watching in step 1. In step 2, the number of televisions did not significantly increase the amount of variability accounted for in the prediction of physical activity. In step 3, housing density and the interaction of housing density by sex accounted for an incremental 12% (p < 0.05) of the variability and in step 4 percentage park plus recreation area accounted for a further 10% (p < 0.05) of the variability. Greater housing density predicted increased physical activity of boys, but not girls. CONCLUSION: Neighborhoods with increased proximity between homes and a greater proportion of park area are associated with greater physical activity in young children.

Relationship of mother and child food purchases as a function of price: a pilot study.

To our knowledge, there are no data on parental influences on child purchasing behavior of healthy or unhealthy foods. Mothers and children in ten families were given 5.00 US dollars to purchase portions of preferred fruits/vegetables and high energy-dense snack foods for each of ten trials of price manipulations. For five of the trials the price of the fruit/vegetable increased in price from 0.50 US dollars to 2.50 US dollars (in 0.50 US dollar increments), while the price of the energy-dense snack food remained constant at 1.00 US dollar. For the remaining five trials, the commodity that previously rose in price remained constant at 1.00 US dollars and the other commodity varied from 0.50 US dollars to 2.50 US dollars. Same-price elasticity was shown for both the child and parent purchases, and parent purchases were significantly related to child purchases of both healthy (regression estimate = 0.46, p < 0.001) and unhealthy (regression estimate = 0.12, p = 0.036) foods. Children's purchases of unhealthy snack food items were positively related to family socioeconomic status, and negatively related to child age. These results indicate that parental food choice and purchasing behaviors may play a role in the development of children's purchasing of both healthy and unhealthy foods.

Purchases of food in youth. Influence of price and income.

One way to increase choice of healthy over unhealthy behaviors is to increase the cost of less healthy alternatives or reduce the cost of healthier alternatives. The influence of price on purchases of healthy and unhealthy foods was evaluated in two laboratory experiments. In Experiment 1, thirty-two 10- to 12-year-old youth were given $5.00 and allowed to purchase multiple portions of a healthy food (fruit or vegetable) and a less healthy food (higher-fat snack). The price of one type of food varied from $0.50 to $2.50, while the price of the other type was held at $1.00. Increasing the price of a type of food reduced purchases of that type of food, but did not lead to substitution with the alternative type of food. In Experiment 2, twenty 10- to 14-year-old youth were given $1.00, $3.00, and $5.00 to purchase healthy and unhealthy foods. The price of each food was raised and lowered by 25% and 50%. Raising the price of healthy or unhealthy foods resulted in decreased purchases of those foods, and income available interacted with price to predict the pattern of substitution of alternative foods. These results show the potential for controlled laboratory studies of price and food purchases, and show that the substitution of healthier for unhealthy food is related to available money.

Physical activity as a substitute for sedentary behavior in youth.

BACKGROUND: Youth may choose to be sedentary rather than physically active. PURPOSE: The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity. METHODS: Fifty-eight 8- to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases: baseline, increasing, and decreasing targeted sedentary behaviors by 25% to 50%. RESULTS: At baseline, boys were more active than girls (518.9 vs. 401.2 accelerometer counts/min, p = .02), and obese youth more sedentary than nonobese youth (240.5 vs. 174.4 min/day, p = .003). During the increase sedentary behavior phase, targeted sedentary behaviors increased by 52.1%, with girls increasing sedentary behaviors more than boys (114.7 vs. 79.8 min/day, p = .04). Physical activity decreased (-48.3 counts/min, p < .01) when sedentary behaviors increased, with obese youth decreasing total and moderate to vigorous physical activity (MVPA) more than nonobese youth (-110.4 vs. 8.9 counts/min, p < .001; -3.3 vs. -.03 % MVPA, p = .013). During the decrease sedentary behavior phase, targeted sedentary behaviors decreased by 55.6% from baseline as nonobese youth increased physical activity, whereas obese youth decreased physical activity (55.8 vs. -48.0 counts/min, p = .042; 1.1 vs. -2.1% MVPA, p = .021). Youth who substituted physical activity when sedentary behaviors were increased had greater standardized body mass index (z-body mass index = 1.4 vs. 0.4, p = .018), whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline (396.1 vs. 513.7 counts/min, p = .035). CONCLUSIONS: Behavioral economics provides a methodology to understand changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors.

Longitudinal assessment of hormonal and physical alterations during normal puberty in boys. IV: Predictions of adult height by the Bayley-Pinneau, Roche-Wainer-Thissen, and Tanner-Whitehouse methods compared.

To determine how accurately the Roche-Wainer-Thissen (RWT), Tanner-Whitehouse (TW2), and Bayley-Pinneau (BP) prediction models estimated adult height, serial height predictions were made for 23 healthy boys (mean initial age 10.4 ± 1.1 years) every 8 months from 8-15 years of age. The RWT model was tested using Greulich-Pyle (RWT-GP) and Fels (RWT-Fels) bone ages. Stature was measured every 4 months until near final height was attained (growth rate <1cm · 8 mo-1). Mean age at near final height was 18.4 ± 1.4 years. To assure that the predictions were as accurate and precise as possible, bone age assessments were made by experts in each method. To investigate the influence of maturation on the predictions, the boys were grouped by Fels bone ages: <11 yr, 11-13.99 yr, and 14-14.99 yr. Comparison of the prediction bias and of the root mean square errors (RMSE) showed that the TW2 model gave the most accurate results, followed by the RWT and BP models. The adult height was generally underpredicted by the TW2 model and overpredicted by the RWT and BP models. The RMSE was reduced for each of the models as the bone age approached maturity. The TW2 model had the smallest average RMSE in all bone age groups. In the <11 yr bone age group, the RWT-Fels, RWT-GP, and BP models produced RMSEs that were 16.4%, 18.4%, 62.1%, respectively, greater than the TW2 model. For the 11-13.99 yr group, RMSE by the RWT-Fels, RWT-GP, and BP models were 7.5%, 18.0%, and 15.2%, respectively, greater than the TW2 model. In the 14-14.99 yr group the RWT-GP model had a 45.5% greater RMSE than the TW2 model, whereas the RWT-Fels model produced a RMSE only 15.2% greater than TW2. The RWT-Fels model produced a lower RMSE than the RWT-GP model for all bone age groups. Although the data are probably as accurate and precise as presently possible, biologically significant error remains, especially with overprediction of adult height in normally growing boys by the BP and RWT models. It is recommended that regardless of the prediction model implemented, caution be used when advising patients of their predicted adult height since all of the models tested had outlying predictions. Am. J. Hum. Biol. 9:371-380, 1997. © 1997 Wiley-Liss, Inc.