Impact of a transitional care program for heart failure patients at Baylor Scott & White Health: a pilot study.

Heart failure is a chronic health condition characterized by complex symptom management and costly hospitalizations. Hospitalization for the treatment of heart failure symptoms is common; however, many hospitalizations are thought to be preventable with effective self-management. This study describes the small, pilot implementation of a new, interventional, self-management heart failure program, "Engagement in Heart Failure Care" (EHFC), developed to assist heart failure patients with the management of disease symptoms following discharge from an inpatient hospital stay. EHFC was designed to engage patients in managing their symptoms and coaching them in skills that enable them to access medical and supportive care services across community, clinic, and hospital settings to help address both their current and future needs. The results of this pilot study suggest that EHFC's coaching model may have positive benefits on key health and well-being indicators of the patients enrolled.

Understanding Libraries as Part of the Rural Active Living Environment: Evidence From a Content Analysis of Library Facebook Posts Made in Summer 2022.

As both public health and public libraries continue to evolve, there are opportunities for collaboration focused on building policies, systems, and environments that support communities making healthy choices easy choices. Given the health disparities related to physical inactivity, such as diabetes and heart disease in rural America, public libraries within rural communities are emerging as important settings for health promotion and disease prevention. This study sought to better understand how rural libraries promote physical activity opportunities on Facebook. Based on a content analysis of Facebook posts of a random sample of 118 libraries made during the Summer of 2022, 47 of the 118 had at least one post related to physical activity and 42 had multiple posts. The most frequent offering was events or classes; libraries also supported physical activity by lending equipment and making changes to the built environment. This study provides evidence that some rural libraries are offering physical activity opportunities through community health partnerships, particularly for youth and families. Considering this evidence, public health professionals are encouraged to collaborate with local libraries to promote physical activity and advance rural health equity. Researchers are invited to continue to develop the evidence base around promoting physical activity with rural libraries.

Urban-rural disparities in childhood obesogenic environments in the United States: Application of differing rural definitions.

BACKGROUND: Research is needed that identifies environmental resource disparities and applies multiple rural definitions. Therefore, this study aims to examine urban-rural differences in food and physical activity (PA) environment resource availability by applying several commonly used rural definitions. We also examine differences in resource availability within urban-rural categories that are typically aggregated. METHODS: Six food environment variables (access to grocery/superstores, farmers' markets, fast food, full-service restaurants, convenience stores, and breastfeeding-friendly facilities) and 4 PA environment variables (access to exercise opportunities and schools, walkability, and violent crimes) were included in the childhood obesogenic environment index (COEI). Total COEI, PA environment, and food environment index scores were generated by calculating the average percentile for related variables. US Department of Agriculture Urban Influence Codes, Office of Management and Budget codes, Rural-Urban Continuum Codes, Census Bureau Population Estimates for percent rural, and Rural Urban Commuting Area Codes were used. One-way ANOVA was used to detect urban-rural differences. RESULTS: The greatest urban-rural disparities in COEI (F=310.2, P<.0001) and PA environment (F=562.5, P<.0001) were seen using RUCC codes. For food environments, the greatest urban-rural disparities were seen using Census Bureau percent rural categories (food: F=24.9, P<.0001). Comparing remote rural categories, differences were seen for food environments (F=3.1, P=.0270) and PA environments (F=10.2, P<.0001). Comparing metro-adjacent rural categories, differences were seen for PA environment (F=4.7, P=.0090). CONCLUSION: Findings inform future research on urban and rural environments by outlining major differences between urban-rural classifications in identifying disparities in access to health-promoting resources.

Environmental Factors Associated with Physical Activity in Rural U.S. Counties.

BACKGROUND: Rural U.S. adults' prevalence of meeting physical activity (PA) guidelines is lower than urban adults, yet rural-urban differences in environmental influences of adults' PA are largely unknown. The study's objective was to identify rural-urban variations in environmental factors associated with the prevalence of adults meeting PA guidelines. METHODS: County-level data for non-frontier counties (n = 2697) were used. A five-category rurality variable was created using the percentage of a county's population living in a rural area. Factor scores from Factor Analyses (FA) were used in subsequent Multiple Linear Regression (MLR) analyses stratified by rurality to identify associations between environmental factor scores and the prevalence of males and females meeting PA guidelines. RESULTS: FA revealed a 13-variable, four-factor structure of natural, social, recreation, and transportation environments. MLR revealed that natural, social, and recreation environments were associated with PA for males and females, with variation by sex for social environment. The natural environment was associated with PA in all but urban counties; the recreation environment was associated with PA in the urban counties and the two most rural counties. CONCLUSIONS: Variations across the rural-urban continuum in environmental factors associated with adults' PA, highlight the uniqueness of rural PA and the need to further study what succeeds in creating active rural places.

Examining the Implementation of Play Streets: A Systematic Review of the Grey Literature.

CONTEXT: Outdoor play has been described as essential for healthy childhood development. Lack of safety is one barrier to children participating in outdoor play. Play Streets are an intervention to help increase outdoor play by temporarily closing public streets (closures are recurring or episodic) to traffic, creating a safe place for active play. OBJECTIVE: This systematic grey literature review aimed to examine and describe what is known about implementing Play Streets using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, which is widely used in implementation research. DESIGN: A systematic search for and review of nonacademic, or grey, literature was conducted using Academic Search Complete, Google Scholar, and a general Google search. ELIGIBILITY CRITERIA: Included literature was published in English, through December 2017, in nonacademic sources (ie, organizational/grant/municipal reports, newspapers, conference presentations, previous intervention advertisement materials, Web-based articles) or found in reference lists of academic articles about Play Streets, Pop-up Parks, or Open Streets/Ciclovías with a Play Street component. STUDY SELECTION: Resources were selected that documented Play Streets, which are defined as recurring or episodic temporary street closures to traffic that provide the public with a no-cost, safe space to actively play and be physically active. These approaches are designed primarily for youth and may include various marked play areas, loose equipment, and/or group activities. MAIN OUTCOME MEASURES: RE-AIM measures guided data extraction. RESULTS: Of the 36 articles composing the final sample, 100% reported on implementation, although the level of detail varied. Only 14 of 36 articles reported measures of effectiveness; limited information was provided for other RE-AIM components. CONCLUSIONS: In the grey literature, there are several inconsistencies in how the implementation of Play Streets is reported and level of detail. Specific details regarding implementing and evaluating Play Streets are needed to support widespread replication.

Sibship, physical activity, and sedentary behavior: a longitudinal, observational study among Mexican-heritage sibling dyads.

BACKGROUND: Shared genetic and environmental factors suggest that family relationships are important predictors of obesity-related behaviors, yet little is known about how siblings influence physical activity and sedentary behaviors. This study examined physical activity and sedentary behavior between sibling dyads across summer and fall time points and determined if birth order and gender modify the relationship between sibling behaviors. METHODS: Mexican-heritage families residing in colonias along the United States-Mexico border were recruited using promotoras de salud to participate in summer and school year surveys. Eighty-seven sibling dyads had complete data for the physical activity sub-study: 21 older brother-younger brother, 21 older brother-younger sister, 23 older sister-younger brother, and 22 older sister-younger sister dyads. Physical activity and sedentary behavior were measured using a validated 7-day recall instrument to create summary measures of weekly active, moderate-to-vigorous physical activity (MVPA) metabolic equivalents (MET), sitting, and screen time minutes. We used linear regression analyses to examine changes over time and the association between older and younger sibling behavior. RESULTS: During summer, older siblings (mean age = 11.2 years) reported 1069 active minutes and 1244 sitting minutes per week; younger siblings (mean age = 8.3 years) reported 1201 active minutes and 1368 sitting minutes per week. Younger brothers reported fewer active minutes (mean = - 459.6; p = 0.01) and fewer MVPA MET-minutes (mean = - 2261.7; p = 0.02) of physical activity during the fall. Within all 87 dyads, older sibling physical activity was significantly associated with younger sibling active minutes (B = 0.45;p = 0.004) and MET-minutes (B = 0.45;p = 0.003) during summer but not fall; older sibling sedentary behavior was significantly associated with younger sibling sitting (B = 0.23;p = 0.01) and screen time minutes (B = 0.23;p = 0.004) during fall but not summer. After stratifying by gender dyad groups, younger brother behavior was strongly associated with older brother behavior at both time points. CONCLUSION: Younger siblings appear to emulate the physical activity behaviors of their older siblings during non-school summer months and sedentary behaviors of older siblings during school-time fall months, especially older brother-younger brother dyads. Family-based interventions to increase physical activity and decrease sedentary behavior are growing in popularity, but more work is needed to understand the role of sibling influences.

Simple screening tools to identify limited health literacy in a low-income patient population.

Adults with limited health literacy have difficulty managing chronic conditions, higher hospitalization rates, and more healthcare expenditures. Simple screening tools have been developed, but limited work has evaluated instruments among low-income populations. This study assessed health literacy among primary care patients of a federally qualified health center, and compared a single screening question about perceived difficulty completing medical forms.A cross-sectional survey was administered to English-speaking patients ≥40 years. Both the Newest Vital Sign (NVS), a 6-item questionnaire, and a single-item screening question about perceived difficulty with completing medical forms, assessed health literacy. Logistic regression was used to identify predictors of inadequate health literacy and receiver operator curves compared the NVS and single-item question.Participants (n = 406) were, on average, aged 58.5 years (±11.3), 72.2% female, and identified as Hispanic/Latino (19.2%), non-Hispanic white (31.0%), non-Hispanic black (40.9%), or other (8.9%). Of the 406 participants, 335 (82.5%) completed the NVS. Patients who declined NVS were more likely to be older (P < .001) and male (P = .01). Only 13.7% had adequate health literacy. Older adults, Hispanic and non-Hispanic black patients, patients with missed office visits, and those reporting less confidence completing medical forms were significantly more likely to have inadequate health literacy. Perceived confidence completing medical forms demonstrated low sensitivity but high specificity at multiple thresholds.This is the first investigation to compare the NVS and confidence completing medical forms question. Many patients declined health literacy assessments, but health literacy screening may identify patients who need additional health education and resources.

A Systematic Review of Rural, Theory-based Physical Activity Interventions.

OBJECTIVES: This systematic review synthesized the scientific literature on theory-based physical activity (PA) interventions in rural populations. METHODS: PubMed, PsycINFO, and Web of Science databases were searched to identify studies with a rural study sample, PA as a primary outcome, use of a behavioral theory or model, randomized or quasi-experimental research design, and application at the primary and/or secondary level of prevention. RESULTS: Thirty-one studies met our inclusion criteria. The Social Cognitive Theory (N = 14) and Transtheoretical Model (N = 10) were the most frequently identified theories; however, most intervention studies were informed by theory but lacked higher-level theoretical application and testing. Interventions largely took place in schools (N = 10) and with female-only samples (N = 8). Findings demonstrated that theory-based PA interventions are mostly successful at increasing PA in rural populations but require improvement. CONCLUSIONS: Future studies should incorporate higher levels of theoretical application, and should explore adapting or developing rural-specific theories. Study designs should employ more rigorous research methods to decrease bias and increase validity of findings. Follow-up assessments to determine behavioral maintenance and/or intervention sustainability are warranted. Finally, funding agencies and journals are encouraged to adopt rural-urban commuting area codes as the standard for defining rural.

Internal consistency, convergent validity, and structural validity of the Japanese version of the Physical Activity Self-Regulation scale (PASR-12) among Japanese workers: A validation study.

OBJECTIVES: Self-regulation for physical activity is considered as one of the most effective factors in promoting physical activity. However, there is no reliable and valid scale to measure it in Japanese. The purpose of this study was to investigate the internal consistency, convergent validity, and structural validity of the newly developed Japanese version of the 12-item Physical Activity Self-Regulation scale (PASR-12) among Japanese workers. METHODS: A cross-sectional Internet-based survey recruiting 516 Japanese workers was conducted in Japan. The PASR-12 was translated according to the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) task force guidelines. Physical activity and self-efficacy for physical activity were measured as comparisons for convergent validity. We calculated Cronbach's alphas, and conducted correlational analyses and confirmatory factor analysis (CFA). RESULTS: Of 516 workers, 485 workers were eligible for all analyses. Cronbach's alpha for the scale scores ranged from 0.79 to 0.95. The scores of the total and 6 factor scales of the Japanese version of the PASR-12 had small-to-moderate positive correlations with the total physical activity and self-efficacy. Moreover, the 6-factor hypothesized model demonstrated excellent fit (χ2 (39) = 100.74, CFI = 0.973, RMSEA = 0.057). CONCLUSIONS: The Japanese version of the PASR-12 showed good reliability and factor-based and construct validity. Therefore, this scale could be applied to assess self-regulation for physical activity among Japanese workers.

Theoretical Antecedents of Standing at Work: An Experience Sampling Approach Using the Theory of Planned Behavior.

Time spent sitting has been associated with an increased risk of diabetes, cancer, obesity, and mental health impairments. However, 75% of Americans spend most of their days sitting, with work-sitting accounting for 63% of total daily sitting time. Little research examining theory-based antecedents of standing or sitting has been conducted. This lack of solid groundwork makes it difficult to design effective intervention strategies to decrease sitting behaviors. Using the Theory of Planned Behavior (TPB) as our theoretical lens to better understand factors related with beneficial standing behaviors already being practiced, we examined relationships between TPB constructs and time spent standing at work among "positive deviants" (those successful in behavior change). Experience sampling methodology (ESM), 4 times a day (midmorning, before lunch, afternoon, and before leaving work) for 5 consecutive workdays (Monday to Friday), was used to assess employees' standing time. TPB scales assessing attitude (α = 0.81-0.84), norms (α = 0.83), perceived behavioral control (α = 0.77), and intention (α = 0.78) were developed using recommended methods and collected once on the Friday before the ESM surveys started. ESM data are hierarchically nested, therefore we tested our hypotheses using multilevel structural equation modeling with Mplus. Hourly full-time university employees (n = 50; 70.6% female, 84.3% white, mean age = 44 (SD = 11), 88.2% in full-time staff positions) with sedentary occupation types (time at desk while working ≥6 hours/day) participated. A total of 871 daily surveys were completed. Only perceived behavioral control (ß = 0.45, p < 0.05) was related with work-standing at the event-level (model fit: just fit); mediation through intention was not supported. This is the first study to examine theoretical antecedents of real-time work-standing in a naturalistic field setting among positive deviants. These relationships should be further examined, and behavioral intervention strategies should be guided by information obtained through this positive deviance approach to enhance perceived behavioral control, in addition to implementing environmental changes like installing standing desks.

Gender differences in college leisure time physical activity: application of the theory of planned behavior and integrated behavioral model.

OBJECTIVE: National data consistently report that males participate in leisure time physical activity (LTPA) at higher rates than females. This study expanded previous research to examine gender differences in LTPA of college students using the theory of planned behavior (TPB) by including 2 additional constructs, descriptive norm and self-efficacy, from the integrated behavioral model. PARTICIPANTS: Participants were college students (N = 621) from a large public university in the southeastern United States. METHODS: A self-report, classroom-based assessment with validated and reliable measures of LTPA, TPB constructs, descriptive norm, self-efficacy, and demographics was conducted in fall 2009. RESULTS: Regression analyses revealed attitude (ß = .119), intention (ß = .438), self-efficacy (ß = .166), body mass index (BMI) (ß = -.084), and sports participation (ß = .081) as significantly associated with LTPA for females (R (2) = .425, p < .001), whereas intention (ß = .371) was significant for males (R (2) = .202, p < .001). CONCLUSIONS: Practitioners should consider tailoring promotional materials to address these gender differences in efforts to increase LTPA participation among college students.

Walk@Work: An automated intervention to increase walking in university employees not achieving 10,000 daily steps.

OBJECTIVE: This study assessed the workday step counts of lower active (<10,000 daily steps) university employees using an automated, web-based walking intervention (Walk@Work). METHODS: Academic and administrative staff (n=390; 45.6±10.8years; BMI 27.2±5.5kg/m(2); 290 women) at five campuses (Australia [x2], Canada, Northern Ireland and the United States), were given a pedometer, access to the website program (2010-11) and tasked with increasing workday walking by 1000 daily steps above baseline, every two weeks, over a six week period. Step count changes at four weeks post intervention were evaluated relative to campus and baseline walking. RESULTS: Across the sample, step counts significantly increased from baseline to post-intervention (1477 daily steps; p=0.001). Variations in increases were evident between campuses (largest difference of 870 daily steps; p=0.04) and for baseline activity status. Those least active at baseline (<5000 daily steps; n=125) increased step counts the most (1837 daily steps; p=0.001), whereas those most active (7500-9999 daily steps; n=79) increased the least (929 daily steps; p=0.001). CONCLUSIONS: Walk@Work increased workday walking by 25% in this sample overall. Increases occurred through an automated program, at campuses in different countries, and were most evident for those most in need of intervention.