Associations of social cohesion and quality of life with objective and perceived built environments: a latent profile analysis among seniors.

BACKGROUND: Healthy aging requires support from local built and social environments. Using latent profile analysis, this study captured the multidimensionality of the built environment and examined relations between objective and perceived built environment profiles, neighborhood social cohesion and quality of life among seniors. METHODS: In total, 693 participants aged 66-97 were sampled from two US locales in 2005-2008 as part of the Senior Neighborhood Quality of Life Study (SNQLS). Perceived social cohesion and quality of life were assessed using validated surveys. Six objective (geographic information system (GIS)-based) and seven perceived built environment latent profiles generated in previous SNQLS publications were used for analyses. Mixed-effects models estimated social cohesion and quality of life separately as a function of the built environment profiles. RESULTS: More walkable and destination-rich perceived built environment profiles were associated with higher social cohesion and quality of life. Objective built environment profiles were not associated with social cohesion and only positively associated with quality of life in only one locale (Baltimore/DC). CONCLUSIONS: Latent profile analysis offered a comprehensive approach to assessing the built environment. Seniors who perceived their neighborhoods to be highly walkable and recreationally dense experienced higher neighborhood social cohesion and quality of life, which may set the stage for healthier aging.

Where and when adolescents are physically active: Neighborhood environment and psychosocial correlates and their interactions.

Female adolescents are less active than male peers in certain contexts including the neighborhood. Adolescents' physical activity can be explained by interactions between environmental and psychosocial factors, but few studies have tested such interactions in relation to context-specific behaviors. This study tested interactions between neighborhood environmental and psychosocial factors in relation to adolescents' context-specific physical activity. Data were collected in 2009-11 from 910 adolescents and a parent/guardian residing in the Baltimore/Seattle regions. Measures included adolescent-reported neighborhood leisure-time physical activity (LTPA) and non-neighborhood LTPA, accelerometer-based non-school moderate-to vigorous-physical activity (MVPA), psychosocial factors, and objective and parent-perceived neighborhood environmental factors. Gender-stratified mixed effects linear models tested associations of 6 environmental and 4 psychosocial factors and their interactions in relation to each physical activity outcome. The psychosocial factors had consistent associations with the physical activity outcomes but the environmental correlates were context-specific. Decisional balance (weighing of pros and cons of physical activity) moderated the association between recreation facility density and neighborhood LTPA among females, with a negative association only among those with high decisional balance (pros outweighed cons). Decisional balance also moderated associations of neighborhood walkability with non-school MVPA among females and non-neighborhood LTPA among males, with positive associations only among those with high decisional balance. Results support context-specific ecological models of physical activity. Targeting environmental factors that may promote opportunities for physical activity in specific contexts as well as adolescent decision-making may help promote their physical activity in those contexts, potentially leading to increased overall physical activity.

Interactions between individual and perceived environmental factors on Latinas' physical activity.

Background: Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA. Methods: We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA. Results: Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women. Conclusions: Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.

Active school transport and fast food intake: Are there racial and ethnic differences?

OBJECTIVES: To investigate whether active school transport was associated with fast food consumption, and to examine differences across racial/ethnic groups. METHODS: Adolescent data (n=3194) from the 2009 California Health Interview Survey were analyzed with logistic regression models to examine the association between active school transport (AST) and fast food intake across racial/ethnic groups. RESULTS: In the overall sample, AST during 1-2days in the past week was associated with greater likelihood of fast food intake (OR: 1.58; 95% CI: 1.03-2.43), compared with zero days of AST, controlling for demographic and other factors. The association between AST and fast food intake differed significantly by race/ethnicity (p<0.01). Among Latino adolescents, greater frequency of AST was significantly associated with greater likelihood of fast food intake (1-2days OR, 2.37, 95%CI: 1.05-5.35; 3-4days OR, 2.78, 95% CI: 1.04-7.43; 5days OR, 2.20, 95%CI: 1.23-3.93). Among White and Asian adolescents, there was a curvilinear pattern: relative to adolescents who reported zero days of AST, those who did AST 1-2days/week had greater likelihood of fast food intake, but AST of 3-4days and 5days/week was associated respectively, with higher and lower likelihood of fast food intake among both groups. CONCLUSIONS: AST appears to be a risk factor for fast food intake, and may expose some ethnic groups more than others to increased opportunity to purchase and consume fast food. Programs and policies to promote AST among adolescents should incorporate efforts to encourage healthy eating and discourage concentration of fast food outlets near schools.

International study of objectively measured physical activity and sedentary time with body mass index and obesity: IPEN adult study.

BACKGROUND: Physical activity (PA) has been consistently implicated in the etiology of obesity, whereas recent evidence on the importance of sedentary time remains inconsistent. Understanding of dose-response associations of PA and sedentary time with overweight and obesity in adults can be improved with large-scale studies using objective measures of PA and sedentary time. The purpose of this study was to examine the strength, direction and shape of dose-response associations of accelerometer-based PA and sedentary time with body mass index (BMI) and weight status in 10 countries, and the moderating effects of study site and gender. METHODS: Data from the International Physical activity and the Environment Network (IPEN) Adult study were used. IPEN Adult is an observational multi-country cross-sectional study, and 12 sites in 10 countries are included. Participants wore an accelerometer for seven consecutive days, completed a socio-demographic questionnaire and reported height and weight. In total, 5712 adults (18-65 years) were included in the analyses. Generalized additive mixed models, conducted in R, were used to estimate the strength and shape of the associations. RESULTS: A curvilinear relationship of accelerometer-based moderate-to-vigorous PA and total counts per minute with BMI and the probability of being overweight/obese was identified. The associations were negative, but weakened at higher levels of moderate-to-vigorous PA (>50 min per day) and higher counts per minute. No associations between sedentary time and weight outcomes were found. Complex site- and gender-specific findings were revealed for BMI, but not for weight status. CONCLUSIONS: On the basis of these results, the current Institute of Medicine recommendation of 60 min per day of moderate-to-vigorous PA to prevent weight gain in normal-weight adults was supported. No relationship between sedentary time and the weight outcomes was present, calling for further examination. If moderator findings are confirmed, the relationship between PA and BMI may be country- and gender-dependent, which could have important implications for country-specific health guidelines.

The development of a walkability index: application to the Neighborhood Quality of Life Study.

Emerging evidence supports a link between neighbourhood built environment and physical activity. Systematic methodologies for characterising neighbourhood built environment are needed that take advantage of available population information such as census-level demographics. Based on transportation and urban planning literatures, an integrated index for operationalising walkability using parcel-level information is proposed. Validity of the walkability index is examined through travel surveys among areas examined in the Neighborhood Quality of Life Study (NQLS), a study investigating built environment correlates of adults' physical activity.

Validating stage of change measures for physical activity and dietary behaviors for overweight women.

OBJECTIVE: To investigate the construct, concurrent and predictive validity of stage of change measures for physical activity (PA), and intakes of fruit and vegetables (FVs), dietary fiber (FB) and dietary fat (DF) among a sample of overweight women. DESIGN: Subjects were 401 women (mean age=41, s.d.=8.7 years; mean body mass index=32.35, s.d.=4.6) recruited to participate in a 12-month weight loss intervention trial. Concurrent validity tests included (1) self-report of current behavior, (2) decisional balance (for example, pros and cons of behavior change), (3) self-efficacy, (4) the MTI Actigraph accelerometer (for the PA staging measure), and (5) a food-frequency questionnaire (for all dietary staging measures). Predictive validity was assessed through tests of the relationship between the baseline stage of change measures and their corresponding behavior 1-year later. RESULTS: Coefficient alpha-tests of internal consistency exceeded 0.70 on the majority of scales. Concurrent validity tests indicated strong validity evidence for three staging measures and little validity for the DF staging measure (eta(2) range, 0.02-0.18). All staging algorithms demonstrated predictive validity (eta(2) range, 0.04-0.126). CONCLUSION: Staging measures can determine motivational readiness for overweight women, contribute to the standardization of stage of change assessment and facilitate cross-study comparisons.

Perceived Neighborhood Environmental Factors That Maximize the Effectiveness of a Multilevel Intervention Promoting Physical Activity Among Latinas.

PURPOSE: This study tested whether a multilevel physical activity (PA) intervention had differential effects on PA according to participants' perceptions of their neighborhood environment. DESIGN: Two-group cluster randomized controlled trial. SETTING: San Diego, California. SUBJECTS: Analytical sample included 319 Latinas (18-65 years) from churches randomized to the following conditions: PA (n = 8 churches, n = 157 participants) or attention control (n = 8 churches, n = 162 participants). INTERVENTION: Over 12 months, PA participants were offered free PA classes (6/wk), while attention control participants were offered cancer prevention workshops. MEASURES: Baseline and 12-month follow-up measures included self-report and accelerometer-based moderate to vigorous physical activity (MVPA), sociodemographics, and perceived neighborhood environment variables. ANALYSIS: Mixed-effects models examined each PA outcome at 12-month follow-up, adjusted for church clustering, baseline PA, and sociodemographics. We tested interactions between 7 baseline perceived environment variables and study condition. RESULTS: Neighborhood esthetics was the only significant moderator of intervention effects on accelerometer-based MVPA and self-report leisure-time MVPA. Participants in the PA intervention had significantly higher PA at follow-up than attention control participants, only when participants evaluated their neighborhood esthetics favorably. CONCLUSION: Perceived neighborhood esthetics appeared to maximize the effectiveness of a multilevel PA intervention among Latinas. For sustainable PA behavior change, the environments in which Latinas are encouraged to be active may need to be evaluated prior to implementing an intervention to ensure they support active lifestyles.

A research agenda to guide progress on childhood obesity prevention in Latin America.

Childhood obesity rates in Latin America are among the highest in the world. This paper examines and evaluates the many efforts underway in the region to reduce and prevent further increases in obesity, identifies and discusses unique research challenges and opportunities in Latin America, and proposes a research agenda in Latin America for the prevention of childhood obesity and concomitant non-communicable diseases. Identified research gaps include biological challenges to healthy growth across the life cycle, diet and physical activity dynamics, community interventions promoting healthy child growth, and rigorous evaluation of national food and activity programs and regulatory actions. Addressing these research gaps is critical to advance the evidence-based policy and practice in childhood obesity tailored to the Latin American context that will be effective in addressing obesity.

Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity.

Lifestyle factors related to obesity, eating behavior, and physical activity play a major role in the prevention and treatment of type 2 diabetes. In recent years, there has been progress in the development of behavioral strategies to modify these lifestyle behaviors. Further research, however, is clearly needed, because the rates of obesity in our country are escalating, and changing behavior for the long term has proven to be very difficult. This review article, which grew out of a National Institute of Diabetes and Digestive and Kidney Diseases conference on behavioral science research in diabetes, identifies four key topics related to obesity and physical activity that should be given high priority in future research efforts: 1) environmental factors related to obesity, eating, and physical activity; 2) adoption and maintenance of healthful eating, physical activity, and weight; 3) etiology of eating and physical activity; and 4) multiple behavior changes. This review article discusses the significance of each of these four topics, briefly reviews prior research in each area, identifies barriers to progress, and makes specific research recommendations.

Independent and combined influence of neonatal and current body composition on academic performance in youth: The UP & DOWN Study.

BACKGROUNDS: Unhealthy body composition is a cause for concern across the lifespan. OBJECTIVE: The objective of this study was to examine the independent and combined associations between neonatal and current body composition with academic performance among youth. METHODS: This cross-sectional study was conducted with a total of 1557 youth (745 girls) aged 10.4 ± 3.4 years. Birth weight and length at birth were self-reported. Current body composition was assessed by body mass index (BMI), waist circumference (WC) and percentage of body fat (BF%). Academic performance was assessed through schools records. RESULTS: Birth weight was related to all academic variables in boys, independent of potential confounders, including BMI; whereas WC, BMI and BF% were related to all academic performance indicators in both boys and girls, independent of potential confounders, including birth weight (all P < 0.05). In addition, the combined adverse effects of low birth weight and current overweight on academic performance were observed in both boys and girls for grade point average (GPA) indicator. Boys in the group with none adverse effect had significantly higher scores in GPA (score +0.535; 95% confidence interval, 0.082-0.989) than boys in the group of both adverse effects (P < 0.007); among girls, GPA score was higher in the group with none adverse effect than in the groups with one or two adverse effects (P for trend = 0.029). CONCLUSIONS: Neonatal and current body composition, both independently and combined, may influence academic performance in youth.

Adult heart disease prevention in childhood: a national survey of pediatricians' practices and attitudes.

There is controversy about the role of pediatric care givers in reducing presumed risk factors for cardiovascular diseases in children. A national mail survey of 2,000 pediatricians was designed to determine the attitudes, current practices, and knowledge among primary care pediatricians regarding these risks. The response rate was 60% (779 primary care pediatricians). Responses indicated that a majority of pediatricians take a family history of cardiovascular diseases, assess BP, recommend exercise to school-aged children, and advise patients and parents against smoking. Few pediatricians felt confident in their ability to affect change in patient life-styles. There was a relatively low level of provision of dietary advice, and most pediatricians do not measure serum cholesterol levels, except in high-risk older children. A substantial minority do not discuss smoking, even with adolescents. Practices and attitudes varied with the age of the patient. Obesity was the topic most frequently chosen for continuing medical education. Older pediatricians were most likely to advocate and practice risk reduction in children. Attitudes and reported practices also varied by gender and geographic location of the pediatrician as well as the ethnic composition of the practice. Implications for continuing medical education are discussed.

Examination of the factor structure of physical activity behaviors.

Multiple physical activity recommendations exist for behaviors that vary in type and intensity (e.g., vigorous physical activity, strengthening exercises, moderate physical activity). The present study examined underlying dimensions of physical activity behaviors and determined the extent to which factors correspond to national health recommendations. Fifteen variables were drawn from six self-report measures and subjected to factor analysis with quartimax rotation. Participants were 547 university seniors (56% female; 60% Caucasian; mean age = 25 years). TV watching, the only index of sedentary behavior, did not load highly with other items, and was analyzed separately. Three interpretable factors were found: variables related to vigorous physical activity loaded highly on Factor 1; flexibility and strengthening items loaded highly on Factor 2; and moderate and housework activity loaded highly on Factor 3. Factors corresponded closely to national recommendations. Unweighted factor scores and TV watching correlated significantly with physiological indicators of fitness, supporting construct validity.

Ethnic, socioeconomic, and sex differences in physical activity among adolescents.

Regular physical activity is recommended for health maintenance in adolescence, but basic descriptive epidemiological data are lacking for this age group. The present study examined socioeconomic status (SES), ethnic, and sex differences in physical activity in a multiethnic sample of 1871 high school students in San Diego, California. Surveys were completed in required classes by a diverse sample of students from a low-income school district and by Anglo students from a nearby more affluent district. Boys reported more vigorous exercise outside of school and during school physical education, as well as more participation in sports teams, but girls reported taking more activity-related lessons and classes. High-SES students had more frequent physical education classes, spent more time in vigorous exercise in those classes, and participated in more activity lessons outside of school. There were few ethnic differences on summary physical activity or physical education variables. There were no SES differences, but there were ethnic differences on 5 of 22 specific activities. Demographic differences in 25 psychological, social, and environmental variables that may influence physical activity were also examined. Differences between boys and girls were found on several variables, which may explain some of the boys' higher activity levels. Ethnic and/or SES differences were found in 10 of 25 potential correlates of physical activity. These data may be used to identify specific activities that may be preferred by subgroups of adolescents and specific mediating variables that can be targeted in physical activity promotion programs for adolescents.

Reliability and validity of self-reported physical activity in Latinos.

The reliability and validity of six self-report physical activity measures were assessed in Latino adults. Validity was assessed by caltrac activity monitors, 'significant others', and construct analyses. Vigorous activity measures had higher reliability and validity (e.g. r > 0.40, P < 0.05) than moderate intensity measures. Though measures varied in their validity, the use of standard physical activity measures with Latinos was supported, and recommendations for specific measures were provided.

Project SPARK. Effects of physical education on adiposity in children.

Project SPARK evaluates multiple effects of a health-related physical education (PE) program for elementary school students. Seven schools were randomly assigned to one of three conditions: usual PE or control, trained classroom teachers, or PE specialists. The intervention was implemented throughout the fourth and fifth grades. Data are available from one cohort of 550 children who were measured in the fall and spring of both grades. Adiposity was assessed by triceps and calf skinfolds, and body mass index (BMI) was also measured. Data at each measurement point were analyzed by ANOVAs, covarying for baseline values. At no measurement point were there significant group differences in total skinfold. At both fifth grade measurement points for boys and girls, however, there was a trend for the control group to have higher skinfold values than the two intervention groups. At the final measure, the difference between the highest and lowest groups was about 3 mm for girls and 2 mm for boys. BMIs were significantly lower at some measurement points for boys and girls, but this could be due to increased lean body mass in intervention students. After two years, there was a trend for the children exposed to the PE intervention to have lower levels of body fat, but the differences were not significant.

A physical activity screening measure for use with adolescents in primary care.

OBJECTIVE: To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings. STUDY DESIGN: We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity. RESULTS: In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable. CONCLUSION: The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.

Factors parents use in selecting play spaces for young children.

BACKGROUND: The amount of time children spend in play spaces (ie, physical locations that are appropriate for children's physical activity) near their homes is correlated with their level of physical activity. OBJECTIVE: To examine factors used in parents' decisions about the selection of play spaces for their children. SUBJECTS: Parents (primarily mothers) of 178 Mexican American and 122 white children who were a mean age of 4.9 years old at the first measurement. MEASURES: In individual interviews, parents rated 24 factors on their importance in selecting for their children a play space that is away from their home or yard. Decision factors were rated from 1 (ie, not important at all) to 5 (ie, very important). RESULTS: The most important factors, with ratings ranging from 4.8 to 4.2, were safety and availability of toilets, drinking water, lighting, and shade. Mexican American parents rated 8 of 24 items significantly higher than did white parents, including lighted at night, organized activities, play supplies, and drinking water. White parents rated 5 of 24 items significantly higher than did Mexican American parents, including distance from home, cost of admission, and child's friends go there. The rated importance of 7 of 24 items increased during 1 year, including play supplies, drinking water, distance from home, and parents' friends or relatives go there. CONCLUSIONS: These results indicate that parents can identify factors they use in selecting places for their young children to play, and selection factors differ somewhat by ethnicity or socioeconomic status. Further studies are needed to determine whether improvements on the most important selection factors might be effective in increasing the use of play spaces by children and their parents. Clinicians may be able to use the most highly rated decision factors to help parents assess the acceptability of play spaces in their areas.

A multicomponent program for nutrition and physical activity change in primary care: PACE+ for adolescents.

BACKGROUND: Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. PARTICIPANTS: Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. INTERVENTION: Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. MEASURES: Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. RESULTS: All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. CONCLUSIONS: A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Environmental and policy interventions to promote physical activity.

BACKGROUND: Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults. METHOD: Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed. RESULTS: Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries. PROPOSED MODEL: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary. CONCLUSION: Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.