Self-management processes, sedentary behavior, physical activity and dietary self-management behaviors: impact on muscle outcomes in continuing care retirement community residents.

BACKGROUND: Despite the known benefits of non-sedentary behavior, physical activity, and protein and caloric intake to health and muscle mass, strength, and function, many older adults do not meet physical activity and dietary recommendations. A better understanding of the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes (muscle mass, strength, and function) is needed, particularly among continuing care retirement community residents. The objective of this study was to examine the factors associated with sedentary behavior, physical activity and dietary self-management behaviors, and muscle outcomes among continuing care retirement community residents. It also aimed to determine whether sedentary behavior and physical activity and dietary self-management behaviors mediate the relationships between self-efficacy, goal congruence, aging expectations, social support, and muscle outcomes. METHODS: A sample of 105 continuing care retirement community residents (age > 70 years) participated in this correlational, cross-sectional study. Questionnaires on pain, self-efficacy, goal congruence, aging expectation, social support, and daily protein and caloric intake were administered. Physical activity and sedentary behavior (ActiGraph wGT3X-BT), muscle mass (ImpediMed SFB7), muscle strength (Jamar Smart Digital Hand Dynamometer), and muscle function (Short Physical Performance Battery) were measured. Multiple regression, logistic regression, and mediation analyses were performed. RESULTS: Low goal congruence predicted engagement in sedentary behavior and light physical activity. Higher levels of self-efficacy and social support were associated with increased likelihoods of achieving greater moderate physical activity and meeting daily recommendations for caloric intake, respectively. Self-efficacy and goal congruence predicted muscle function and strength. Moreover, sedentary behavior and achieving greater moderate physical activity were found to partially but significantly mediate the relationship between self-efficacy and muscle function. CONCLUSION: Future research should evaluate whether attempts to reduce sedentary behavior and promote physical activity and dietary self-management behaviors and muscle outcomes are more successful when modifications to the self-management process factors are also targeted.

Catalyzing Transdisciplinarity: A Systems Ethnography of Cancer-Obesity Comorbidity and Risk Coincidence.

Effectively addressing wicked health problems, that is, those arising from complex multifactorial biological and socio-economic causes, requires transdisciplinary action. However, a significant body of research points toward substantial difficulties in cultivating transdisciplinary collaboration. Accordingly, this article presents the results of a study that adapts Systems Ethnography and Qualitative Modeling (SEQM) in response to wicked health problems. SEQM protocols were designed to catalyze transdisciplinary responses to national defense concerns. We adapted these protocols to address cancer-obesity comorbidity and risk coincidence. In so doing, we conducted participant-observations and interviews with a diverse range of health care providers, community health educators, and health advocacy professionals who target either cancer or obesity. We then convened a transdisciplinary conference designed to catalyze a coordinated response. The findings offer productive insights into effective ways of catalyzing transdisciplinarity in addressing wicked health problems action and demonstrate the promise of SEQM for continued use in health care contexts.

Translating exercise interventions to an in-home setting for seniors: preliminary impact on physical activity and function.

AIMS: The purpose of this study is to investigate whether an in-home, individually tailored intervention is efficacious in promoting increases in physical activity (PA) and improvements in physical functioning (PF) in low-active older adults. METHODS: Participants were randomized to two groups for the 8-week intervention. The enhanced physical activity (EPA) group received individualized exercise programming, including personalized step goals and a resistance band training program, and the standard of care (SoC) group received a general activity goal. Pre- and post-intervention PF measures included choice step reaction time, knee extension/flexion strength, hand grip strength, and 8 ft up and go test completion time. RESULTS: Thirty-nine subjects completed this study (74.6 ± 6.4 years). Significant increases in steps/day were observed for both the EPA and SoC groups, although the improvements in the EPA group were significantly higher when including only those who adhered to weekly step goals. Both groups experienced significant PF improvements, albeit greater in the EPA group for the 8 ft up and go test and knee extension strength. CONCLUSION: A low cost, in-home intervention elicited improvements in both PA and PF. Future research is warranted to expand upon the size and scope of this study, exploring dose thresholds (and time frames) for PA to improve PF and strategies to further bolster adherence rates to maximize intervention benefits.

Environmental conditions in low-income urban housing: clustering and associations with self-reported health.

OBJECTIVES: We explored prevalence and clustering of key environmental conditions in low-income housing and associations with self-reported health. METHODS: The Health in Common Study, conducted between 2005 and 2009, recruited participants (n = 828) from 20 low-income housing developments in the Boston area. We interviewed 1 participant per household and conducted a brief inspection of the unit (apartment). We created binary indexes and a summed index for household exposures: mold, combustion by-products, secondhand smoke, chemicals, pests, and inadequate ventilation. We used multivariable logistic regression to examine the associations between each index and household characteristics and between each index and self-reported health. RESULTS: Environmental problems were common; more than half of homes had 3 or more exposure-related problems (median summed index = 3). After adjustment for household-level demographics, we found clustering of problems in site (P < .01) for pests, combustion byproducts, mold, and ventilation. Higher summed index values were associated with higher adjusted odds of reporting fair-poor health (odds ratio = 2.7 for highest category; P < .008 for trend). CONCLUSIONS: We found evidence that indoor environmental conditions in multifamily housing cluster by site and that cumulative exposures may be associated with poor health.

Physically active, low-income African American women: an exploration of activity maintenance in the context of sociodemographic factors associated with inactivity.

Increasing physical activity among low-income African American women is an important target for addressing racial and economic disparities in chronic conditions and related risk factors. While barriers to physical activity for women have been examined empirically, successful strategies for navigating those barriers among physically active, low-income women have not been thoroughly explored. Informed by grounded theory, we conducted in-depth individual interviews between 2007-2010 with 14 low-income African American women who were physically active at nationally recommended levels for one year or more. We analyzed the data using thematic analysis techniques. Key themes emerged in three main categories: motivation for maintaining active lifestyle, strategies for maintaining physical activity, and challenges to maintaining physical activity. Important motivations included getting or staying healthy, social connections, and gratification. Two planning strategies emerged: flexibility and freedom. Critical challenges included financial constraints, physical strain and history of sedentary relapse. The motivations, strategies and challenges reported by low-income African American women who successfully maintained an active lifestyle provided important information for developing effective health promotion strategies for their inactive and underactive counterparts. A qualitative, asset-based approach to physical activity research contributes rich data to bridge the gap between epidemiological knowledge and community health improvement.

"You learn to go last": perceptions of prenatal care experiences among African-American women with limited incomes.

African American infants die at higher rates and are at greater risk of adverse birth outcomes than White infants in Milwaukee. Though self-reported experiences of racism have been linked to adverse health outcomes, limited research exists on the impact of racism on women's prenatal care experiences. The purpose of this study was to examine the experiences of racial discrimination during prenatal care from the perspectives of African American women in a low income Milwaukee neighborhood. Transcripts from six focus groups with twenty-nine women and two individual interviews were analyzed to identify important emergent themes. Validity was maintained using an audit trail, peer debriefing, and two individual member validation sessions. Participants identified three areas of perceived discrimination based on: (1) insurance or income status, (2) race, and (3) lifetime experiences of racial discrimination. Women described being treated differently by support staff and providers based on type of insurance (public versus private), including perceiving a lower quality of care at clinics that accepted public insurance. While some described personally-mediated racism, the majority of women described experiences that fit within a definition of institutionalized racism-in which the system was designed in a way that worked against their attempts to get quality prenatal care. Women also described lifetime experiences of racial discrimination. Our findings suggest that African American women with limited incomes perceive many provider practices and personal interactions during prenatal care as discriminatory. Future studies could explore the relationship between perceptions of discrimination and utilization of prenatal care.

Physical activity among Amish and non-Amish adults living in Ohio Appalachia.

To understand the behavioral lifestyle factors that may contribute to lower cancer incidence rates among the Amish population, this study evaluated differences in physical activity (PA) levels between Amish and non-Amish adults living in Ohio Appalachia. Amish (n = 134) and non-Amish (n = 154) adults completed face-to-face interviews as part of a cancer-related lifestyle study. Self-report of PA level was measured by the International Physical Activity Questionnaire (IPAQ) and by a diary of steps/day (pedometer: Digi-Walker SW-200). Total metabolic equivalent tasks (MET) minutes was calculated from the IPAQ and average number of steps/day from a pedometer diary. Amish males walked more steps/day (mean ± standard error (SE): 11,447 ± 611 vs. 7,605 ± 643; P < 0.001) and had a higher IPAQ score (MET min/week) (mean ± SE: 8,354 ± 701 vs. 5,547 ± 690; P < 0.01) than non-Amish males. In addition, Amish farmers walked significantly more steps/day than Amish non-farmers (mean ± SE: 15,278 ± 1,297 vs. 10,742 ± 671; P < 0.01). There was a trend for Amish females to walk more steps/day (mean ± SE: 7,750 ± 477 vs. 6,547 ± 437; P = 0.06) and to have higher IPAQ scores (mean ± SE: 4,966 ± 503 vs. 3,702 ± 450; P = 0.06) compared to non-Amish females. Two measures of PA demonstrated a higher PA level among Amish males, especially farmers, and a trend for higher PA level among Amish females. Higher levels of PA warrants further investigation as one factor potentially contributing to lower cancer incidence rates documented among the Amish.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Elements of external validity of tools for health: an intervention for construction laborers.

PURPOSE: To examine the external validity of an efficacious tailored smoking cessation and nutrition improvement telephone intervention. DESIGN: Comparison of characteristics of participants and nonparticipants (representativeness); examination of the extent of intervention implementation. SETTING: Cancer center collaboration with a labor union. SUBJECTS: Unionized construction laborers. INTERVENTION: Tailored feedback report, telephone counseling, and supplementary educational materials focused on smoking cessation and improved nutrition. MEASURES: Background survey identifying socio-demographic and behavioral characteristics; process evaluation data; and final efficacy survey to determine participant satisfaction. ANALYSIS: Cross-classification and the chi(2) test of homogeneity were used with categorically measured variables comparing participants and nonparticipants. We compared the means in the two groups for continuously scaled measures using the Student t-test and investigated the multivariable association of the characteristics of participation with a multiple logistic regression. For process data we present frequencies, percentages, and means. RESULTS: Characteristics associated with participation included self-efficacy to change fruit and vegetable consumption (p = .0009) and self-identification with union's problems (p = 0.05). Eighty-six percent of non-smokers and 61% of smokers completed between 1 and 4 counseling sessions. Over one-half of non-smokers (61%) and smokers (53%) completed 4 or more calls and more smokers (34%) than non-smokers (11%) completed the 5+ sessions. CONCLUSIONS: These results provide a snapshot of characteristics of construction laborers to whom this intervention can be generalized and indicators of feasibility necessary for translating research into practice.

Multiple health behavior changes in a cancer prevention intervention for construction workers, 2001-2003.

INTRODUCTION: Few multiple behavior change interventions have addressed tobacco use in conjunction with fruit and vegetable consumption, particularly among high-risk blue-collar workers. Tools for Health, a cancer prevention intervention for construction laborers, was effective in achieving behavior change for smoking cessation and fruit and vegetable consumption separately. This study examines whether addressing smoking and fruit and vegetable consumption was successful in achieving positive change for both behaviors. We also explored possible explanations for the relationship between behavior changes in these 2 behavioral domains. METHODS: We retrospectively analyzed data from a randomized controlled trial testing a smoking cessation and fruit and vegetable consumption intervention for construction workers. We used survey data from 300 intervention participants to answer our primary research question: Did participants who reported being smokers at baseline successfully quit smoking and increase their fruit and vegetable consumption by the end of the intervention? We used qualitative data from 16 small group discussions to help interpret these results. RESULTS: Tools for Health participants achieved substantial levels of smoking cessation and increased their fruit and vegetable consumption, concurrently, during the course of the intervention. CONCLUSION: This study provides evidence that pairing smoking cessation with increasing fruit and vegetable consumption can be successful in a multiple behavior change intervention designed for high-risk blue-collar workers. Further, our findings provide potential directions for examining why this pairing might be complementary.

No Longer an Island: A Social Network Intervention Engaging Black Men Through CBPR.

The aim of this study was to assess outcomes from a multilevel social network intervention to promote the health of Black men. Through a community-academic collaboration and using a participatory research approach, we implemented the intervention over 4 years in a 110-block area of an urban neighborhood. The project aimed to implement a neighborhood peer outreach and leadership network to strengthen social support of Black men and increase community and family engagement. Intervention activities included three 12-month intergenerational peer support groups (N = 46), a door-to-door outreach campaign (N = 186), media and communication efforts, and a community partner network. Primary outcomes for the peer support groups were measured using a pretest/posttest cohort design and included social support, perceived stress, social capital, and global self-esteem. Primary outcomes for the door-to-door outreach campaign were measured using a repeated cross-sectional design and included a sense of community, neighborhood social interaction, perceived neighborhood control, and self-rated health status. Significant findings from the peer support groups included an increase in social support overall (p = .027), driven by improvements in guidance, reliable alliance, and reassurance of worth; and an improvement in perceived stress (p = .047). Significant findings from the door-to-door outreach campaign included increases in neighborhood social interaction (p < .0001) and perceived neighborhood control (p = .036). This project provides evidence that a participatory approach to planning and delivering a health promotion intervention aimed at creating positive social spaces and enhancing social connections can result in significant outcomes and successful engagement of Black men.

Developing long-term physical activity participation: a grounded theory study with African American women.

Regular physical activity is linked to a reduced risk of obesity and chronic disease. African American women bear a disproportionate burden from these conditions and many do not get the recommended amount of physical activity. Long-term success of interventions to initiate and maintain a physically active lifestyle among African American women has not been realized. By clearly elucidating the process of physical activity adoption and maintenance, effective programming could be implemented to reduce African American women's burden from chronic conditions. In-depth interviews were conducted with physically active African American women. Grounded theory, a rigorous qualitative research method used to develop theoretical explanation of human behavior grounded in data collected from those exhibiting that behavior, was used to guide the data collection and analysis process. Data derived inductively from the interviews and focus groups guided the development of a behavioral framework explaining the process of physical activity evolution.

Youth Chef Academy: Pilot Results From a Plant-Based Culinary and Nutrition Literacy Program for Sixth and Seventh Graders.

BACKGROUND: National data confirm that youth are not eating recommended amounts of fruits and vegetables (F/V), legumes, and whole grains (WGs). Establishing plant-based eating patterns early in life may positively impact long-term health through tracking of adolescent eating patterns into adulthood and through potential associations between adolescent dietary intake and adult disease risk. The study aim was to examine the effectiveness of Youth Chef Academy (YCA), a classroom-based experiential culinary and nutrition literacy intervention for sixth and seventh graders (11- to 13-year-olds) designed to impact healthy eating. METHODS: Study used a nonequivalent control group design with 8 schools selected for similarity in: free/reduced-price lunch, race/ethnicity, and student mobility rate (N = 248). Primary outcomes were times per day of F/V, vegetable, and WG consumption. Students completed a survey to assess primary outcomes and other measures at baseline and post-intervention. RESULTS: Significant increases in times per day of F/V (p = .022) and vegetable only (p = .015) consumption in the intervention group compared to the control group. Increases in WG consumption showed trended toward significance (p = .071). Student engagement and nutrition knowledge showed significant intervention effects. CONCLUSIONS: YCA positively impacts behavioral and knowledge variables related to healthy eating and increases students' engagement in their classrooms.

The Efficacy of a Walking Intervention Using Social Media to Increase Physical Activity: A Randomized Trial.

BACKGROUND: Facebook may be a useful tool to provide a social support group to encourage increases in physical activity. This study examines the efficacy of a Facebook social support group to increase steps/day in young women. METHODS: Female college freshmen (N = 63) were randomized to one of two 8-week interventions: a Facebook Social Support Group (n = 32) or a Standard Walking Intervention (n = 31). Participants in both groups received weekly step goals and tracked steps/day with a pedometer. Women in the Facebook Social Support Group were also enrolled in a Facebook group and asked to post information about their steps/day and provide feedback to one another. RESULTS: Women in both intervention arms significantly increased steps/day pre- to postintervention (F(8,425) = 94.43, P < .001). However, women in the Facebook Social Support Group increased steps/day significantly more (F(1,138) = 11.34, P < .001) than women in the Standard Walking Intervention, going from 5295 to 12,472 steps/day. CONCLUSIONS: These results demonstrate the potential effectiveness of using Facebook to offer a social support group to increase physical activity in young women. Women in the Facebook Social Support Group increased walking by approximately 1.5 miles/day more than women in the Standard Walking Intervention which, if maintained, could have a profound impact on their future health.

Does concern motivate behavior change? Exploring the relationship between physical activity and body mass index among low-income housing residents.

OBJECTIVE: To explore relationships between concerns and physical activity and body mass index (BMI) among a racially/ethnically diverse low-income population. METHOD: A cross-sectional survey documented behavioral risks among racially/ethnically diverse low-income residents in the Boston area (2005-2009). Multivariable logistic regressions were conducted in 2012 for each concern, using SAS version 9.2. RESULTS: Those very/moderately concerned about weight were more likely to have higher BMIs, be in the preparation/action stage, received behavioral counseling, participated in a weight management program, and be interested in participating in one in the future. Those very/moderately concerned about physical activity were more likely to have higher BMIs, received behavioral counseling, and participated in a physical activity program. CONCLUSION: Individuals with elevated BMIs or low levels of physical activity are concerned. While level of concern is important, these findings suggest that it is not likely to be a sufficient catalyst to behavior change.

Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments.

PURPOSE: To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments. DESIGN: In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting . The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area. SUBJECTS: Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures . Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis . Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors. RESULTS: Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use. CONCLUSION: Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.

Geospatial Relationships between Awareness and Utilization of Community Exercise Resources and Physical Activity Levels in Older Adults.

Introduction. It is unclear if community-based fitness resources (CBFR) translate to heightened activity levels within neighboring areas. The purpose of this study was to determine whether awareness and utilization of fitness resources and physical activity differed depending on residential distance from CBFR. Methods. Four hundred and seventeen older adults (72.9 ± 7.7 years) were randomly recruited from three spatial tiers (≤1.6, >1.6 to ≤3.2, and >3.2 to 8.0 km) surrounding seven senior centers, which housed CBFR. Participants completed questionnaires on health history, CBFR, and physical activity, gathering data on CBFR awareness, utilization, and barriers, overall levels, and predictors to engagement in moderate to vigorous physical activity (MVPA). Results. Across spatial tiers, there were no differences in positive awareness rates of CBFR or CBFR utilization. Engagement in MVPA differed across spatial tiers (P < 0.001), with the >3.2 to 8.0 km radius having the highest mean energy expenditure. Across all sites, age and income level (P < 0.05) were significant predictors of low and high amounts of MVPA, respectively, and current health status and lack of interest represented barriers to CBFR utilization (P < 0.05). Conclusion. Closer proximity to CBFR did not impact awareness or utilization rates and had an inverse relationship with physical activity.

Sociodemographic and social contextual predictors of multiple health behavior change: data from the Healthy Directions-Small Business study.

Multiple modifiable health behaviors contribute to the chronic diseases that are the leading causes of death in the USA. Disparities for meeting recommended health behavior guidelines exist across occupational classes and socioeconomic levels. The purpose of this paper was to investigate sociodemographic and social contextual predictors of multiple health behavior change in a worksite intervention. We analyzed data on four diet and exercise variables from an intervention trial with worksite-level randomization. Eight hundred forty-one employees had complete data from baseline (response rate = 84 %) and follow-up surveys (response rate = 77 %). Multilevel logistic regression estimated associations between least absolute shrinkage and selection operator-selected sociodemographic and social contextual predictor variables and the multiple health behavior change outcome (changing 2+ versus 0 behaviors). Gender, being married/partnered, and perceived discrimination were significantly associated with multiple health behavior change. Sociodemographic and social contextual factors predict multiple health behavior change and could inform the design and delivery of worksite interventions targeting multiple health behaviors.

Financial hardship and self-rated health among low-income housing residents.

BACKGROUND: Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. METHODS: We analyzed cross-sectional data from the Health in Common Study (N = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. RESULTS: Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. CONCLUSION: Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population.

Comparing strategies to assess multiple behavior change in behavioral intervention studies.

BACKGROUND: Alternatives to individual behavior change methods have been proposed, however, little has been done to investigate how these methods compare. PURPOSE: To explore four methods that quantify change in multiple risk behaviors targeting four common behaviors. METHODS: We utilized data from two cluster-randomized, multiple behavior change trials conducted in two settings: small businesses and health centers. Methods used were: (1) summative; (2) z-score; (3) optimal linear combination; and (4) impact score. RESULTS: In the Small Business study, methods 2 and 3 revealed similar outcomes. However, physical activity did not contribute to method 3. In the Health Centers study, similar results were found with each of the methods. Multivitamin intake contributed significantly more to each of the summary measures than other behaviors. CONCLUSIONS: Selection of methods to assess multiple behavior change in intervention trials must consider study design, and the targeted population when determining the appropriate method/s to use.