Impact of Sit-to-Stand and Treadmill Desks on Patterns of Daily Waking Physical Behaviors Among Overweight and Obese Seated Office Workers: Cluster Randomized Controlled Trial.

BACKGROUND: Sit-to-stand and treadmill desks may help sedentary office workers meet the physical activity guideline to "move more and sit less," but little is known about their long-term impact on altering the accumulation patterns of physical behaviors. OBJECTIVE: This study explores the impact of sit-to-stand and treadmill desks on physical behavior accumulation patterns during a 12-month multicomponent intervention with an intent-to-treat design in overweight and obese seated office workers. METHODS: In total, 66 office workers were cluster randomized into a seated desk control (n=21, 32%; 8 clusters), sit-to-stand desk (n=23, 35%; 9 clusters), or treadmill desk (n=22, 33%; 7 clusters) group. Participants wore an activPAL (PAL Technologies Ltd) accelerometer for 7 days at baseline, 3-month follow-up (M3), 6-month follow-up (M6), and 12-month follow-up (M12) and received periodic feedback on their physical behaviors. Analyses of physical behavior patterns included total day and workday number of sedentary, standing, and stepping bouts categorized into durations ranging from 1 to 60 and >60 minutes and usual sedentary, standing, and stepping bout durations. Intervention trends were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. RESULTS: The treadmill desk group favored prolonged sedentary bouts (>60 min), whereas the sit-to-stand desk group accrued more short-duration sedentary bouts (<20 min). Therefore, compared with controls, sit-to-stand desk users had shorter usual sedentary bout durations short-term (total day ΔM3: -10.1 min/bout, 95% CI -17.9 to -2.2; P=.01; workday ΔM3: -20.3 min/bout, 95% CI -37.7 to -2.9; P=.02), whereas treadmill desk users had longer usual sedentary bout durations long-term (total day ΔM12: 9.0 min/bout, 95% CI 1.6-16.4; P=.02). The treadmill desk group favored prolonged standing bouts (30-60 min and >60 min), whereas the sit-to-stand desk group accrued more short-duration standing bouts (<20 min). As such, relative to controls, treadmill desk users had longer usual standing bout durations short-term (total day ΔM3: 6.9 min/bout, 95% CI 2.5-11.4; P=.002; workday ΔM3: 8.9 min/bout, 95% CI 2.1-15.7; P=.01) and sustained this long-term (total day ΔM12: 4.5 min/bout, 95% CI 0.7-8.4; P=.02; workday ΔM12: 5.8 min/bout, 95% CI 0.9-10.6; P=.02), whereas sit-to-stand desk users showed this trend only in the long-term (total day ΔM12: 4.2 min/bout, 95% CI 0.1-8.3; P=.046). The treadmill desk group accumulated more stepping bouts across various bins of duration (5-50 min), primarily at M3. Thus, treadmill desk users had longer usual stepping bout durations in the short-term compared with controls (workday ΔM3: 4.8 min/bout, 95% CI 1.3-8.3; P=.007) and in the short- and long-term compared with sit-to-stand desk users (workday ΔM3: 4.7 min/bout, 95% CI 1.6-7.8; P=.003; workday ΔM12: 3.0 min/bout, 95% CI 0.1-5.9; P=.04). CONCLUSIONS: Sit-to-stand desks exerted potentially more favorable physical behavior accumulation patterns than treadmill desks. Future active workstation trials should consider strategies to promote more frequent long-term movement bouts and dissuade prolonged static postural fixity. TRIAL REGISTRATION: ClinicalTrials.gov NCT02376504; https://clinicaltrials.gov/ct2/show/NCT02376504.

Companion: A Pilot Randomized Clinical Trial to Test an Integrated Two-Way Communication and Near-Real-Time Sensing System for Detecting and Modifying Daily Inactivity among Adults >60 Years-Design and Protocol.

Supervised personal training is most effective in improving the health effects of exercise in older adults. Yet, low frequency (60 min, 1-3 sessions/week) of trainer contact limits influence on behavior change outside sessions. Strategies to extend the effect of trainer contact outside of supervision and that integrate meaningful and intelligent two-way communication to provide complex and interactive problem solving may motivate older adults to "move more and sit less" and sustain positive behaviors to further improve health. This paper describes the experimental protocol of a 16-week pilot RCT (N = 46) that tests the impact of supplementing supervised exercise (i.e., control) with a technology-based behavior-aware text-based virtual "Companion" that integrates a human-in-the-loop approach with wirelessly transmitted sensor-based activity measurement to deliver behavior change strategies using socially engaging, contextually salient, and tailored text message conversations in near-real-time. Primary outcomes are total-daily and patterns of habitual physical behaviors after 16 and 24 weeks. Exploratory analyses aim to understand Companion's longitudinal behavior effects, its user engagement and relationship to behavior, and changes in cardiometabolic and cognitive outcomes. Our findings may allow the development of a more scalable hybrid AI Companion to impact the ever-growing public health epidemic of sedentariness contributing to poor health outcomes, reduced quality of life, and early death.

Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial.

BACKGROUND: Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. OBJECTIVE: This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. METHODS: A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. RESULTS: Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). CONCLUSIONS: These findings suggest that the use of a mobile app-delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. TRIAL REGISTRATION: ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354.

Effects of an "Active-Workstation" Cluster RCT on Daily Waking Physical Behaviors.

PURPOSE: This study aimed to evaluate the effects of sit-to-stand and treadmill desks on sedentary behavior during a 12-month, cluster-randomized multicomponent intervention with an intent-to-treat design in overweight office workers. METHODS: Sixty-six office workers were cluster-randomized into a control (n = 21; 8 clusters), sit-to-stand desk (n = 23; 9 clusters), or treadmill desk (n = 22; 7 clusters) group. Participants wore an activPAL™ accelerometer for 7 d at baseline, month 3, month 6, and month 12 and received periodic feedback on their physical behaviors. The primary outcome was total daily sedentary time. Exploratory outcomes included total daily and workplace sedentary, standing and stepping time, and the number of total daily and workplace sedentary, standing, and stepping bouts. Intervention effects were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects. RESULTS: Total daily sedentary time did not significantly differ between or within groups after 12 months. Month 3 gains were observed in total daily and workplace standing time in both intervention groups (sit-to-stand desk: mean Δ ± SD, 1.03 ± 1.9 h·d-1 and 1.10 ± 1.87 h at work; treadmill desk: mean Δ ± SD, 1.23 ± 2.25 h·d-1 and 1.44 ± 2.54 h at work). At month 3, the treadmill desk users stepped more at the workplace than the control group (mean Δ ± SD, 0.69 ± 0.87 h). Month 6 gains in total daily stepping were observed within the sit-to-stand desk group (mean Δ ± SD, 0.82 ± 1.62 h·d-1), and month 3 gains in stepping at the workplace were observed for the treadmill desk group (mean Δ ± SD, 0.77 ± 0.83 h). These trends were sustained through month 12 in only the sit-to-stand desk group. CONCLUSIONS: Active-workstation interventions may cause short-term improvements in daily standing and stepping. Treadmill desk users engaged in fewer sedentary bouts, but sit-to-stand desks resulted in more frequent transitions to upright physical behaviors.

Go&Grow: An Evaluation of a Pervasive Social Exergame for Caregivers of Loved Ones with Dementia.

Caregivers of persons with dementia (PWD) experience higher rates of stress, social isolation, and poor mental and physical health compared to non-caregiving populations. There is a vital need for engaging, sustainable, and scalable resources to support social, physical, and emotional wellbeing amongst caregivers of PWD. To explore this open design space, we designed and conducted a 6-week mixed-method evaluation of Go&Grow, a pervasive social exergame in which flowers grow as users increase physical activity and interact with other caregivers of PWD. Our findings showed that using Go&Grow helped participants relieve stress, increase physical activity, and develop empathy for and patience towards the loved one with dementia that they cared for. At the same time, tension arose as some caregivers desired to learn about the life challenges that Go&Grow users faced, while others hesitated to share such content. We discuss our findings and recommendations for future technology that promotes caregivers' time for themselves, understanding of PWD, and connections with other caregivers.

Online preschool teacher training to promote physical activity in young children: A pilot cluster randomized controlled trial.

This study tested the Wellness Enhancing Physical Activity in Young Children (WE PLAY) program, a 4-week online preschool teacher training, on children's moderate-to-vigorous physical activity (MVPA). In this cluster RCT, six Head Start preschools were randomized to an intervention and comparison group. Children's MVPA was measured using accelerometers at pre- and posttest. The magnitude of the difference in MVPA between groups at posttest was small, but in the expected direction: Δ min/hour = 1.60, 95% CI [-0.97, 4.18], p = .22, Cohen's d = 0.32. We observed a pre/post within group increase in average minutes per hour of MVPA in school with a medium effect size for the intervention group: Δ mean min/hour = 2.09, 95% CI [0.51, 3.67], p = .0096, Cohen's d = 0.42. An increase was not seen for the comparison group: Δ mean min/hour = 0.44, 95% CI [-0.70, 1.59], p = .45, Cohen's d = 0.07. WE PLAY children in 6 hr/day programs gained 63 min of MVPA per week in school, providing preliminary evidence of the benefits of WE PLAY on children's physical activity levels. WE PLAY deserves further testing with larger groups of children and teachers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Effects of Varying Structured Physical Activity Duration on Young Children's and Parents' Activity Levels.

Purpose: The purpose of this study was to examine whether structured physical activity (PA) in a family-based community exercise program affects PA of young children and parents. Method: Twenty-two children (mean ± SD; age, 4.9 ± 2.1 years) and their parents (age, 34.3 ± 7.6 years) participated in unstructured PA sessions followed by either short- or long-duration structured PA sessions, while wearing an ActiGraph GT9X activity monitor on their right hip to estimate PA. Independent t-tests compared children's and parents' PA during short- and long-structured PA sessions. Paired t-tests compared short- versus long-structured PA sessions. A mixed model ANOVA compared PA during unstructured versus structured sessions and between children and parents. Results: Children spent proportionately more time in moderate-to-vigorous PA (MVPA) and had higher accelerometer counts/min than parents during short-structured PA (children:60.9 ± 18.8% vs. parents:17.7 ± 6.8%, children:3870 ± 742 vs. parents:1836 ± 556 counts/min, p < .05) and long-structured PA (children:61.1 ± 20.1% vs. parents:12.6 ± 4.9%, children:3415 ± 758 vs. parents:1604 ± 633 counts/min, p < .05). No statistical differences were found between short- and long-structured PA sessions for proportion of time spent in MVPA or counts/min for children or parents (all, p > .05). Children spent proportionally more time in MVPA and had higher counts/min during unstructured PA compared to structured PA (unstructured MVPA:54.4 ± 3.9% vs. structured MVPA:38.2 ± 4.2%, unstructured counts/min:3830 ± 222 vs. structured counts/min:2768 ± 239 counts/min; p < .05). Conclusions: Children were more active than parents during both the unstructured and structured PA sessions. However, unstructured PA sessions resulted in 63-77% and 10-11% of PA recommendations for children and adults, respectively. Family-based exercise programming can provide an opportunity for children and their parents to attain MVPA during the week.

The theoretical foundation, fidelity, feasibility, and acceptability of a teacher training to promote physical activity among preschoolers in child care: A pilot study.

This article describes the Wellness Enhancing Physical Activity in Young Children (WE PLAY) teacher training, which was designed to assist early childhood educators to promote physical activity among preschoolers in child care. We describe the WE PLAY intervention and its grounding in constructs from theories of health behavior and an implementation science framework. Fidelity, feasibility, and acceptability data from the WE PLAY pilot study, a cluster randomized controlled trial (RCT) with six Head Start programs in Massachusetts. Data, collected between October 2017-May 2018, are from teachers and supervisors at 3 preschool programs who participated in the WE PLAY (intervention) group. To understand program feasibility and acceptability, we used the Usage Rating Profile-Intervention (URP-I; n = 13) and key informant interviews (n = 5). The URP-I is a validated teacher survey with 6 subscales (Acceptability, Understanding, Feasibility, Family-School Collaboration, Systems Climate, and Systems Support). It was administered twice; immediately after users completed the first component, an online training (week 2), and after implementation of all program components (week 4). WE PLAY was implemented as it was intended, and it was considered acceptable and feasible to users. There was an increase in users' understanding of how to implement the program between weeks 2 and 4, and a concomitant decrease in the amount of additional systems-level supports users thought they would need to implement WE PLAY between weeks 2 and 4. WE PLAY was easily understandable and feasible to implement in real world settings, it was highly acceptable to users, and it deserves further testing.

Peer-Based Strategies to Support Physical Activity Interventions for Older Adults: A Typology, Conceptual Framework, and Practice Guidelines.

Despite the documented and well-publicized health and well-being benefits of regular physical activity (PA), low rates of participation have persisted among American older adults. Peer-based intervention strategies may be an important component of PA interventions, yet there is inconsistent and overlapping terminology and a lack of clear frameworks to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current gerontological, health promotion literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper with the goals to: (a) propose a typology of peer-based intervention strategies for use in the PA promotion literature and a variety of modifiable design characteristics, (b) situate peer-based strategies within a broader conceptual framework, and (c) provide practice guidelines for designing, implementing, and reporting peer-based PA programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work.

When Adults Don't Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults.

Physical activity is one of the most promising nonpharmacological, noninvasive, and cost-effective methods of health-promotion, yet statistics show that only a small percentage of middle-aged and older adults engage in the recommended amount of regular exercise. This state of affairs is less likely due to a lack of knowledge about the benefits of exercise than to failures of motivation and self-regulatory mechanisms. Many types of intervention programs target exercise in later life, but they typically do not achieve sustained behavior change, and there has been very little increase in the exercise rate in the population over the last decade. The goal of this paper is to consider the use of effective low-cost motivational and behavioral strategies for increasing physical activity, which could have far-reaching benefits at the individual and population levels. We present a multicomponent framework to guide development of behavior change interventions to increase and maintain physical activity among sedentary adults and others at risk for health problems. This involves a personalized approach to motivation and behavior change, which includes social support, goal setting, and positive affect coupled with cognitive restructuring of negative and self-defeating attitudes and misconceptions. These strategies can lead to increases in exercise self-efficacy and control beliefs as well as self- management skills such as self-regulation and action planning, which in turn are expected to lead to long-term increases in activity. These changes in activity frequency and intensity can ultimately lead to improvements in physical and psychological well-being among middle-aged and older adults, including those from underserved, vulnerable populations. Even a modest increase in physical activity can have a significant impact on health and quality of life. Recommendations for future interventions include a focus on ways to achieve personalized approaches, broad outreach, and maintenance of behavior changes.

Effects of Playing a Serious Computer Game on Body Mass Index and Nutrition Knowledge in Women.

BACKGROUND: Obesity and weight gain is a critical public health concern. Serious digital games are gaining popularity in the context of health interventions. They use persuasive and fun design features to engage users in health-related behaviors in a non-game context. As a young field, research about effectiveness and acceptability of such games for weight loss is sparse. OBJECTIVE: The goal of this study was to evaluate real-world play patterns of SpaPlay and its impact on body mass index (BMI) and nutritional knowledge. SpaPlay is a computer game designed to help women adopt healthier dietary and exercise behaviors, developed based on Self-Determination theory and the Player Experience of Need Satisfaction (PENS) model. Progress in the game is tied to real-life activities (e.g., eating a healthy snack, taking a flight of stairs). METHODS: We recruited 47 women to partake in a within-subject 90-day longitudinal study, with assessments taken at baseline, 1-, 2-, and 3- months. Women were on average, 29.8 years old (±7.3), highly educated (80.9% had BA or higher), 39% non-White, baseline BMI 26.98 (±5.6), who reported at least contemplating making changes in their diet and exercise routine based on the Stages of Change Model. We computed 9 indices from game utilization data to evaluate game play. We used general linear models to examine inter-individual differences between levels of play, and multilevel models to assess temporal changes in BMI and nutritional knowledge. RESULTS: Patterns of game play were mixed. Participants who reported being in the preparation or action stages of behavior change exhibited more days of play and more play regularity compared to those who were in the contemplation stage. Additionally, women who reported playing video games 1-2 hours per session demonstrated more sparse game play. Brief activities, such as one-time actions related to physical activity or healthy food, were preferred over activities that require a longer commitment (e.g., taking stairs every day for a week). BMI decreased significantly (P<.001) from baseline to 3-month follow-up, yielding a large effect size of 1.28. Nutritional knowledge increased significantly (P<.001) from first to third month follow-ups, with an effect size of .86. The degree of change in both outcomes was related to game play, baseline readiness to change, and the extent of video game play in general. CONCLUSIONS: This work demonstrates initial evidence of success for using a serious game as an intervention for health behavior change in real world settings. Our findings also highlight the need to understand not only game effectiveness but also inter-individual differences. Individualizing content and the intervention medium appears to be necessary for a more personalized and long-lasting impact.

"I Do It With Love": Engagement in Caring for People With Dementia.

For caregivers, the impacts of caring for their loved ones with dementia at home are complex. The purpose of this study was to gain understanding of the meaning and experience of engagement for caregivers of individuals with dementia living in the community. Participants are from a culturally diverse population of low-income caregivers and care recipients in the northeastern United States. We conducted in-depth semi-structured interviews with caregivers (n = 17) who were caring for parents, friends, or other relatives with dementia. We used interpretative phenomenological analysis and identified the superordinate themes of connectedness, meaningfulness, acceptance, and vigilance. We conclude that caregiver engagement is a multidimensional phenomenon, with some dimensions being contextual and specific to caregiving. It is a relational concept, referring to a committed, vigilant, and meaningful relationship of caregivers and care recipients as active collaborators. The different aspects of engagement can complement each other, or they can be in contradiction.

Quantitation of Mitochondrial DNA Deletions Via Restriction Digestion/Long-Range Single-Molecule PCR.

Quantification of deletions in mtDNA is a long-standing problem in mutational analysis. We describe here an approach that combines the power of single-molecule PCR of the entire mitochondrial genome with the enrichment of the deletions by restriction digestion. This approach is indispensable if information about wide range of deletion types in a sample is critical, such as in studies concerning distribution of deletion breakpoints (as opposed to approaches where fraction of a single deletion or a limited set of deletions is used as a proxy for total deletion load). Because deletions in a sample are quantified almost exhaustively, the other important application of this approach involves studies where only small amounts of tissue, such as biopsies, are available.

Influence of exercise on the metabolic profile caused by 28 days of bed rest with energy deficit and amino acid supplementation in healthy men.

OBJECTIVE: Muscle loss and metabolic changes occur with disuse [i.e. bed rest (BR)]. We hypothesized that BR would lead to a metabolically unhealthy profile defined by: increased circulating tumor necrosis factor (TNF)-α, decreased circulating insulin-like-growth-factor (IGF)-1, decreased HDL-cholesterol, and decreased muscle density (MD; measured by mid-thigh computerized tomography). METHODS: We investigated the metabolic profile after 28 days of BR with 8 ± 6% energy deficit in male individuals (30-55 years) randomized to resistance exercise with amino acid supplementation (RT, n=24) or amino acid supplementation alone (EAA, n=7). Upper and lower body exercises were performed in the horizontal position. Blood samples were taken at baseline, after 28 days of BR and 14 days of recovery. RESULTS: We found a shift toward a metabolically unfavourable profile after BR [compared to baseline (BLN)] in both groups as shown by decreased HDL-cholesterol levels (EAA: BLN: 39 ± 4 vs. BR: 32 ± 2 mg/dL, RT: BLN: 39 ± 1 vs. BR: 32 ± 1 mg/dL; p<0.001) and Low MD (EAA: BLN: 27 ± 4 vs. BR: 22 ± 3 cm(2), RT: BLN: 28 ± 2 vs. BR: 23 ± 2 cm(2); p<0.001). A healthier metabolic profile was maintained with exercise, including NormalMD (EAA: BLN: 124 ± 6 vs. BR: 110 ± 5 cm(2), RT: BLN: 132 ± 3 vs. BR: 131 ± 4 cm(2); p<0.001, time-by-group); although, exercise did not completely alleviate the unfavourable metabolic changes seen with BR. Interestingly, both groups had increased plasma IGF-1 levels (EAA: BLN:168 ± 22 vs. BR 213 ± 20 ng/mL, RT: BLN:180 ± 10 vs. BR: 219 ± 13 ng/mL; p<0.001) and neither group showed TNFα changes (p>0.05). CONCLUSIONS: We conclude that RT can be incorporated to potentially offset the metabolic complications of BR.

Family gym: a model to promote physical activity for families with young children.

This report describes Family Gym, a family-centered model that (1) provides free access to physical activity for low-income families in the inner city; (2) targets young children (3-8 years) and their families; (3) engages families together in physical activity; and (4) stimulates social interaction among families.

Perspectives of Puerto Rican Adults about Heart Health and a Potential Community Program.

BACKGROUND: Puerto Ricans are the second largest Hispanic group in the U.S. and older adults have significant health disparities. Educational programs that address heart disease risk for this population have rarely been developed and implemented. PURPOSE: To address this gap, the Heart Healthy Initiative for Puerto Rican adults is being developed. To develop it as a participatory program, the community members were asked about their perspectives. METHODS: Five focus groups with 28 participants, aged 45-60, were conducted, transcribed and analyzed using Thematic Analysis. In-depth analysis of meanings of health promoting behaviors, in the context of cultural beliefs and values was carried out. RESULTS: The following themes were identified: Health as balance and integration; Health as connection of self, connection with others; Cultural meanings of lifestyle choices; Stresses and struggles. Participants suggested that the program should have significant variety and a holistic perspective, be sensitive to different needs and motivations, stimulate mutual understanding and shared cultural meanings. DISCUSSION: The program needs to support lifestyle changes which maximally preserve traditions and to introduce multi-level changes. TRANSLATION TO HEALTH EDUCATION PRACTICE: The identified cultural meanings of diet, physical activity and relationships were taken into account to develop the educational curriculum.

Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes.

Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.

Collaborating for impact: a multilevel early childhood obesity prevention initiative.

This article presents Healthy Kids, Healthy Futures, a multilevel initiative in Boston, Massachusetts, which brings major institutions' missions and resources together to address early childhood obesity prevention. Programming is designed to facilitate healthy eating and physical activity in preschool children's home, school, and community environments by engaging parents and early childhood educators in the places where they live, learn, and play. This article describes how established interventions were implemented in a novel setting to engage the parents of children attending Head Start and staff, and presents pilot data from the first 2 years of the initiative. Healthy Kids, Healthy Futures is a feasible initiative, which has shown concrete, positive results that can be replicated.

Acculturation and sociocultural influences on dietary intake and health status among Puerto Rican adults in Massachusetts.

BACKGROUND: Previous studies have shown negative consequences of acculturation on lifestyle factors, health status, and dietary intake of Hispanic immigrants in the US. Despite prevalent type 2 diabetes and low socioeconomic status (SES) among Puerto Rican adults living on the US mainland, little is known about acculturation in this group. OBJECTIVE: We investigated associations among acculturation, lifestyle characteristics, health status, and carbohydrate nutrition in Puerto Rican adults. A secondary objective was to investigate possible confounding and/or effect modification on these associations by SES. DESIGN: Cross-sectional data from the Boston Puerto Rican Health Study, which included 1219 Puerto Ricans in the Boston area, aged 45-75 years. STATISTICAL ANALYSES: Characteristics were compared using ANCOVA, linear trend and Pearson's chi-square tests across quartiles of acculturation. Tests for interaction by poverty status were conducted. Proportional contributions of foods to intake of total carbohydrate and fiber were assessed using SAS RANK. RESULTS: Levels of acculturation were low, despite young age at first arrival to the US mainland (25.4 ± 12.3 y) and long length of stay (34.2 ± 12.2 y). Greater English language use was associated with higher SES, alcohol consumption, physical activity, better perceived health, and less central obesity. Acculturation was associated with lower legume fiber and greater cereal fiber intake. Among those above the poverty threshold, acculturation was associated with lower dietary glycemic index and starch intake, and greater fruit and non-starchy vegetable intake. CONCLUSIONS: In contrast to studies with Mexican Americans, the association of acculturation with dietary quality in these Puerto Rican adults was mixed, but tended toward better carbohydrate quality. Dietary recommendations should include maintenance of traditional, healthful dietary practices including consumption of legumes, but also reduction in refined grains, and greater inclusion of fruit, non-starchy vegetables, and whole grains. Interventions to improve access to better quality carbohydrate sources are necessary for this group disproportionately affected by diabetes.