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.

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.

Intervention to reduce environmental tobacco smoke exposure in Latino children: null effects on hair biomarkers and parent reports.

OBJECTIVE: To evaluate the effectiveness of a lay delivered intervention to reduce Latino children's exposure to environmental tobacco smoke (ETS). The a priori hypothesis was that children living in households that were in the intervention group would have lower exposure over time than measurement only controls. DESIGN: A two group, randomised control trial was conducted. SETTING: Areas of San Diego county with a large Latino population. PARTICIPANTS: 143 Latino parent-child pairs. INTERVENTION: Trained bicultural and bilingual Latina lay community health advisors, or promotoras, conducted problem solving aimed at lowering the target child's exposure to ETS in the household. Six home and telephone sessions were delivered by the promotoras over a four month period. MAIN OUTCOME MEASURES: Outcome measures were collected at baseline, immediately post-intervention, three months post-intervention, and 12 months post-intervention. Four outcomes were considered: (1) parent's paper-and-pencil reports of the child's past month exposure; (2) hair samples from the child analysed for past month nicotine; (3) hair samples from the child analysed for past month cotinine; and (4) per cent confirmed reducers. RESULTS: There were no significant condition-by-time interactions, the term indicative of a differential intervention effect. Significant or near significant time main effects were seen for children's hair cotinine, per cent confirmed reducers, and, in particular, parent reports of exposure. CONCLUSIONS: Applying a lay promotora model to deliver the behavioural problem solving intervention unfortunately was not effective. A likely explanation relates to the difficulty of delivering a relatively complex intervention by lay women untrained in behaviour change theory and research methods.

Pilot test of an Internet virtual world chat room for rural teen smokers.

OVERVIEW: This pilot study evaluated the acceptability and efficacy of an Internet-based virtual reality "world" for teen smoking cessation. Rural teens at six school sites interacted in real-time in the virtual world with a trained cessation counselor and other teen smokers over a 2-month period in seven 1-hour chat sessions. The cessation counselor used motivational interviewing, a "client-centered" nonconfrontational approach to behavior change that has shown promise with behaviors resistant to change. Smoking behavior and attitudes were assessed at baseline, after intervention, and at 1-month follow-up. Significant changes were found in quitting, amount smoked, and intentions to quit. Positive trends were seen in past-week abstinence rates, quit attempts, and attitudes toward quitting.

Parental provision of transportation for adolescent physical activity.

BACKGROUND: Physical activity (PA) is important to adolescents' health. Parent transportation to activity locations is a practical strategy for increasing youth PA that has rarely been examined. DESIGN: Cross-sectional surveys of students and parents. SETTING/PARTICIPANTS: Ethnically diverse students (N=1678; 712 boys, 966 girls; M age=13.0 years) from 24 middle schools (grades six to eight) and their parents completed surveys (response rate=72%). MAIN OUTCOME MEASURES: Frequency of parents transporting adolescents to PA locations was studied in relation to adolescents' reported participation in PA during the previous week and their involvement in sports and activity lessons during the past year. RESULTS: Parents transported adolescents to PA locations 2.13 times per week, with boys being transported more often than girls (p=0.03). Ethnic/racial differences in frequency of transport were evidenced (p=0.002). Parent transportation for PA significantly contributed to girls' total PA (p=0.001) and their participation in sports/activity lessons (p=0.001). Transportation contributed marginally (p=0.06) to boys' total PA, but significantly to their participation in sports/activity lessons (p=0.001). CONCLUSIONS: Parent provision of transportation to activity locations is associated with out-of-school PA in a diverse adolescent population. This variable should be targeted for intervention.

The association of school environments with youth physical activity.

OBJECTIVES: This study assessed the association of school environmental characteristics with student physical activity on campus. METHODS: Physical activity areas (n = 137) at 24 public middle schools were assessed for area type, size, and improvements (e.g., basketball courts). Student physical activity and the presence of equipment and supervision were directly observed before school, after lunch, and after school. RESULTS: Environmental characteristics explained 42% of the variance in the proportion of girls who were physically active and 59% of the variance for boys. CONCLUSIONS: School environments with high levels of supervision and improvements stimulated girls and boys to be more physically active.

Tobacco use and other risk behaviors: cross-sectional and predictive relationships for adolescent orthodontic patients.

BACKGROUND: The purpose of these analyses was to examine the prevalence of selected substance abuse, general and dental health risk, and scholastic risk behaviors and their cross-sectional and predictive relationships with tobacco use among 15, 179 adolescent orthodontic patients in Southern California. METHODS: Subjects were recruited through 154 orthodontists' offices and interviewed by telephone at baseline and two-year posttest. RESULTS: Results show a pattern of increasing prevalence of risk behaviors with age. In most cases, gender differences were small. There were statistically significant positive relationships between each risk behavior and tobacco use status for both boys and girls. Prevalence rates of risk behaviors other than tobacco use were highest for current smokers, intermediate for experimenters, and lowest for respondents reporting that they had never used tobacco. Baseline tobacco use predicted each posttest risk behavior in logistic regression analyses. Principle components analysis (with varimax rotation) of posttest risk practices other than tobacco use yielded three theoretically meaningful factors, all which were predicted by baseline tobacco use in multiple regressions. CONCLUSIONS: These findings show that tobacco use among adolescents can predict subsequent risk practices other than tobacco use as long as two years, and that unhealthy behaviors among teens are interrelated. Orthodontists, who have a high frequency of adolescent patient contact, may be in a unique position to deliver health promotion interventions to their patients; possibly targeting multiple risk behaviors.

Student activity levels, lesson context, and teacher behavior during middle school physical education.

There is little research on students' engagement in physical activity in middle school physical education (PE). We observed student activity, lesson context, and teacher behavior in 430 PE lessons taught by 126 teachers in 24 schools. Variables were analyzed by mixed-model nested analyses of covariance. Boys were more active than girls overall and during skill drills, game play, and free play. Student activity varied by lesson context, with fitness activities producing the most activity. Class size was negatively associated with student activity. Daily PE contributed a weekly total of 25 min of vigorous activity and 83 min of moderate-to-vigorous activity--much less than national objectives. Results suggest that numerous opportunities exist for increasing student physical activity during middle school PE.

Increasing response rates to a smoking survey for U.S. Navy enlisted women.

This study examined the effectiveness of several persistent strategies to increase the response to a smoking survey among newly enlisted U.S. Navy women. The stepped approach, which included the use of incentives, repeated mailings, alternative survey administration modes, and reminders, was evaluated in terms of effects on response rates and response bias. Demographic and baseline smoking-related characteristics were compared for those responding on time to the initial mailed follow-up survey, reluctant respondents who did not respond initially but eventually completed a survey after further prompting, and non-respondents. Results showed that incentives and persistent efforts were effective in substantially increasing the response among 2,231 eligible participants, more than doubling the response rate (from 24.9% to 52.7%). The characteristics of on-time, reluctant, and non-respondents did not differ significantly in terms of sociodemographic characteristics. On the other hand, on-time respondents were different from both reluctant respondents and non-respondents in terms of smoking-related behaviors.

Effect of an eight week smoking ban on women at US navy recruit training command.

OBJECTIVE: To examine the effect of a unique organisational smoking ban on female United States Navy recruits, a population with historically high smoking rates. SETTING AND DESIGN: Study participants were female recruits (n = 5503) entering the Navy recruit training command between March 1996 and March 1997 (12 consecutive months). Participants completed smoking surveys at entry to recruit training (baseline) and again at graduation from training after exposure to an eight week, 24 hour a day smoking ban. Effects of the ban on baseline to graduation changes in perceptions of being a smoker were examined, and relapse rates among baseline ever smokers was assessed three months after leaving recruit training. RESULTS: Among all recruits, 41.4% reported being smokers at entry (that is, reported any smoking in the 30 days before entering recruit training). As a result of the ban, there was a significant reduction (from about 41% to 25%, p < 0.001) in the percentage of all women recruits who reported themselves as smokers, a much larger change than expected had no ban been in place. Relapse at the three month follow up varied according to the type of smoker at entry into the Navy, with rates ranging from 89% relapse among baseline daily smokers to 31% among baseline experimenters. CONCLUSIONS: Findings suggest that the ban provides some smokers who desire to quit with an external impetus and support to do so. However, high relapse rates indicate that more than an organisationally mandated smoking ban during recruit training is needed to help younger smokers, more regular smokers, and those who intend to continue smoking to quit after joining the Navy.

Leisure-time physical activity in school environments: an observational study using SOPLAY.

BACKGROUND: Schools provide settings for physical activity (PA), but objective tools for measuring PA are lacking. We assessed an instrument to directly observe group PA and measured the leisure-time PA of adolescents throughout the school day. METHODS: Leisure-time PA was studied by direct observation in 24 middle schools in Southern California using SOPLAY (System for Observing Play and Leisure Activity in Youth). SOPLAY uses momentary time sampling to record the activity of each individual as sedentary, walking, or very active. RESULTS: The largest proportion of students visited activity areas at lunch time (19.5%), followed by before (4. 1%) and after school (2.1%). More boys than girls visited activity areas before school (33.4 vs 7.7) and at lunch time (148.8 vs 36.7). Boys in areas engaged in more moderate to vigorous PA than girls before school (59.6 vs 40%) and at lunch time (67.7 vs 51.7%). CONCLUSIONS: Few students use opportunities to be physically active during lesiure time at school. Policies and environmental manipulations (e.g., supervision, equipment, structured programs) are needed to attract more adolescents, especially girls, to existing activity areas. The feasibility of SOPLAY for measuring group PA was established.

Ethnic and gender differences in request for and use of low/non-fat foods in bag lunches.

This study examined ethnic and gender differences in frequency of use and request for low-fat or non-fat foods in bag lunches, while controlling for socioeconomic status. Questionnaires were completed by 1,678 middle school students and their parents (72% response). Ethnic distribution included White (51%), Latino (17%), Asian (11%), Multi-ethnic (11%), and African American (8%). Forty-five percent of students (N = 712, 59% female) brought lunch to school a mean of 3.6 (SD = 1.5) days per week. Boys brought lunch more often (M = 3.8 days/week vs. 3.4, respectively), yet requested less low-fat foods than girls. Whites brought lunches with the most low/non-fat items. Ethnic differences also were found in the use of seven specific bag lunch foods and whether these items were regular or low-fat. Because of ethnic and gender differences, different strategies for reducing fat in bag lunches are needed for different groups.

Enhancing response rates to a smoking survey for enlisted U.S. Navy women.

This study examined the effectiveness of a stepped approach for increasing response rates to a mailed follow-up smoking survey among newly enlisted women in the navy. The effect of the stepped approach on response rates and on the characteristics of respondents was evaluated. Also, costs were estimated for each of the steps to determine their relative benefits. Results showed that the stepped approach was effective in more than doubling the survey response rate among smokers. Reluctant respondents did not differ from on-time respondents in terms of demographics or baseline smoking, although nonrespondents were less educated and heavier smokers than on-time and reluctant respondents. Strategies documented here could well apply to survey efforts with other hard-to-reach populations.

Does the US Navy attract young women who smoke?

OBJECTIVE: To assess whether the United States Navy is disproportionately attracting and recruiting female smokers from the civilian sector. METHODS: Standardised comparisons of cigarette use among Navy women recruits and civilian women were conducted with data from a 1996-97 Department of Defense study and the 1994 National Health Interview Survey. RESULTS: Young Navy women recruits (18-22 years) had significantly higher rates of current and heavy smoking than their civilian counterparts after adjusting for differences in sociodemographic characteristics. Smoking rates among older recruits and civilian women (23-30 years) were not significantly different. CONCLUSIONS: It seems that the Navy attracts young civilian women who already smoke, many of whom smoke heavily.

Predictors of tobacco use initiation in adolescents: a two-year prospective study and theoretical discussion.

OBJECTIVE: To test whether baseline data from a randomised clinical trial are predictive of initiation of tobacco use over a two-year follow-up interval, and to discuss results in the context of a theoretical model. DESIGN: Secondary, non-experimental analyses of data collected from a prospective cluster-randomised clinical trial comparing an intervention with a control condition for reduction of tobacco incidence rates. Orthodontic offices in southern California were recruited and randomised to an experimental or control group. Patient participants were sampled within each office, and completed a short survey, repeated two years later. SUBJECTS: 13,923 patients, 11-18 years of age, randomly sampled from each office. MAIN OUTCOME MEASURES: The ability of baseline data to predict initiation of tobacco use over the two-year follow-up interval was tested through a series of logistic regression models. Significant predictors and their interactions were identified in fixed-effects models, and verified in a mixed-effects logistic regression model to account for cluster randomisation. RESULTS: Clinician advice against tobacco use was associated with a lower rate of tobacco use initiation among young people whose peer group considered smoking socially desirable. Rates of initiation increased with age, but this association differed by gender and by whether the adolescent had been offered tobacco within 30 days prior to the baseline assessment. People from minority groups were less likely to initiate tobacco use than whites, and young people engaging in other risk practices were more likely to initiate tobacco use. CONCLUSIONS: Findings support predictions based on learning theory that social processes are critical in the development of health-risk behaviours. Future preventive efforts should target changing the density with which young people encounter pro- and anti-tobacco prompts and consequences in the community.

An adolescent tobacco-use prevention trial in orthodontic offices.

OBJECTIVES: This study examined the effect of an orthodontist-delivered tobacco-use prevention program for adolescents. METHODS: Southern California orthodontic offices were randomly assigned to experimental (n = 77) and control (n = 77) groups. Randomly selected adolescents were interviewed at baseline and 2 years later (n = 15,644). Experimental offices received tobacco prevention training, anti-tobacco materials, and 50 cents for each anti-tobacco "prescription" written. RESULTS: The 30-day tobacco use 2-year incidence rates for the control and experimental groups were 12.6% and 12.0%, respectively; incidence rates for using tobacco more than 100 times were 7.6% and 6.8%. Differences between the groups did not reach significance. Mean prescription compliance was 64.4%. A multivariate logistic model, showed a significant dose response: patients who received more prescriptions had lower incidence rates than those who received few or none (10% vs 14%). CONCLUSIONS: Training, payment, and support did not ensure clinician compliance with prevention services. The dose effect suggests that replication under conditions that would ensure clinician compliance and statistical power would more thoroughly test clinicians' ability to prevent tobacco use.