Psychosocial mediators of a faith-based physical activity intervention: implications and lessons learned from null findings.

Mediation analyses in faith-based physical activity (PA) interventions targeting African-American adults are lacking. The purpose of this study was to examine the psychosocial mediators of a faith-based PA intervention with African-American adults. Churches were randomly assigned to receive immediate or delayed (1-year later) training in PA program implementation. A subsample of participants from randomly selected churches took part in telephone surveys at baseline and at 1 year. The primary outcome was percentage of participants meeting PA recommendations. MacKinnon's product of coefficients was used to test for mediation. Participants (n = 418) from 20 churches completed the baseline and 1-year follow-up surveys. There were no statistically significant changes in PA behavior at 1 year. The intervention had a marginally significant effect on increasing the amount of instrumental church support received by church members. However, none of the psychosocial variables tested were found to be significant mediators of the intervention. Mediation analyses provided insight into potential reasons as to why the Health-e-AME intervention did not change PA. The intervention did not successfully change the targeted mediators hypothesized to change PA. Potential reasons for these shortcomings as well as issues to address in future faith-based studies are discussed.

Soil zinc content, groundwater usage, and prostate cancer incidence in South Carolina.

BACKGROUND: Prostate cancer (PrCA) incidence in South Carolina (SC) exceeds the national average, particularly among African Americans (AAs). Though data are limited, low environmental zinc exposures and down-regulation of prostatic zinc transporter proteins among AAs may explain, in part, the racial PrCA disparity. METHODS: Age-adjusted PrCA rates were calculated by census tract. Demographic data were obtained from the 1990 census. Hazardous waste site locations and soil zinc concentrations were obtained from existing federal and state databases. A geographic information system and Poisson regression were used to test the hypothesis that census tracts with reduced soil zinc concentrations, elevated groundwater use, or more agricultural or hazardous waste sites had elevated PrCA risks. RESULTS: Census tracts with high groundwater use and low zinc concentrations had higher PrCA rate ratios (RR: 1.270; 95% confidence interval: 1.079, 1.505). This effect was not more apparent in areas populated primarily by AAs. CONCLUSION: Increased PrCA rates were associated with reduced soil zinc concentrations and elevated groundwater use, although this observation is not likely to contribute to SC's racial PrCA disparity. Statewide mapping and statistical modeling of relationships between environmental factors, demographics, and cancer incidence can be used to screen hypotheses focusing on novel PrCA risk factors.

Factors associated with physical activity literacy among foster parents.

OBJECTIVES: To explore associations between physical activity (PA) literacy and psychosocial constructs for providing instrumental social support for youth PA. METHODS: Ninety-one foster parents completed surveys assessing PA literacy (overall and specific), perceptions of child PA, coordination, PA enjoyment, psychosocial variables: positive/negative beliefs, normative beliefs, perceived behavioral control (PBC), and self-efficacy. RESULTS: Race, negative beliefs, PBC, and foster parent sport involvement were associated with specific PA literacy. Race and education were associated with overall PA literacy. CONCLUSIONS: Lower PA literacy is associated with greater negative beliefs and lower perceived control suggesting greater perceived barriers and lower perceived support for/among African Americans and those with less education.

Cardiorespiratory fitness as a predictor of dementia mortality in men and women.

UNLABELLED: There is evidence that physical activity may reduce the risk of developing Alzheimer disease and dementia. However, few reports have examined the physical activity-dementia association with objective measures of physical activity. Cardiorespiratory fitness (hereafter called fitness) is an objective reproducible measure of recent physical activity habits. PURPOSE: We sought to determine whether fitness is associated with lower risk for dementia mortality in women and men. METHODS: We followed 14,811 women and 45,078 men, age 20-88 yr at baseline, for an average of 17 yr. All participants completed a preventive health examination at the Cooper Clinic in Dallas, TX, during 1970-2001. Fitness was measured with a maximal treadmill exercise test, with results expressed in maximal METs. The National Death Index identified deaths through 2003. Cox proportional hazards models were used to examine the association between baseline fitness and dementia mortality, adjusting for age, sex, examination year, body mass index, smoking, alcohol use, abnormal ECGs, and health status. RESULTS: There were 164 deaths with dementia listed as the cause during 1,012,125 person-years of exposure. Each 1-MET increase in fitness was associated with a 14% lower adjusted risk of dementia mortality (95% confidence interval (CI) = 6%-22%). With fitness expressed in tertiles, adjusted hazard ratios (HRs) for those in the middle- and high-fitness groups suggest their risk of dementia mortality was less than half that of those in the lowest fitness group (HR = 0.44, CI = 0.26-0.74 and HR = 0.49, CI = 0.26-0.90, respectively). CONCLUSIONS: Greater fitness was associated with lower risk of mortality from dementia in a large cohort of men and women.

Muscular strength and incident hypertension in normotensive and prehypertensive men.

UNLABELLED: The protective effects of cardiorespiratory fitness (CRF) on hypertension (HTN) are well known; however, the association between muscular strength and incidence of HTN has yet to be examined. PURPOSE: This study evaluated the strength-HTN association with and without accounting for CRF. METHODS: Participants were 4147 men (age = 20-82 yr) in the Aerobics Center Longitudinal Study for whom an age-specific composite muscular strength score was computed from measures of a one-repetition maximal leg and a one-repetition maximal bench press. CRF was quantified by maximal treadmill exercise test time in minutes. Cox proportional hazards regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals of incident HTN events according to exposure categories. RESULTS: During a mean follow-up of 19 yr, there were 503 incident HTN cases. Multivariable-adjusted (excluding CRF) HR of HTN in normotensive men comparing middle- and high-strength thirds to the lowest third were not significant at 1.17 and 0.84, respectively. Multivariable-adjusted (excluding CRF) HR of HTN in baseline prehypertensive men comparing middle- and high-strength thirds to the lowest third were significant at 0.73 and 0.72 (P = 0.01 each), respectively. The association between muscular strength and incidence of HTN in baseline prehypertensive men was no longer significant after control for CRF (P = 0.26). CONCLUSIONS: The study indicated that middle and high levels of muscular strength were associated with a reduced risk of HTN in prehypertensive men only. However, this relationship was no longer significant after controlling for CRF.

Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework.

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.

A comparison of two types of social support for mothers of mentally ill children.

PROBLEM: The purpose of this analysis was to compare social support offered by two telehealth nursing interventions for mothers of children with serious mental illnesses. METHODS: A randomized, controlled, quantitative investigation is underway to test two support interventions, using the telephone (TSS) or Internet (WEB). Qualitative description was used to analyze data generated during telehealth interventions. FINDINGS: The behaviors and attitudes of children were challenging for the mothers to manage. Mothers' emotional reactions included fear, frustration, concern, and guilt. They sought to be advocates for their children. The nurses provided emotional, informational, and appraisal support. TSS mothers were passive recipients, while WEB mothers had to choose to participate. CONCLUSIONS: Mothers in both interventions shared similar concerns and sought support related to their child's problems.