Associations Among Leisure-Time Physical Activity, Gestational Weight Gain, and Postpartum Weight Retention With Varying Estimates of Prepregnancy Weight.

Prospective studies examining postpartum weight retention (PPWR) in relation to the appropriateness of gestational weight gain (GWG) and leisure-time physical activity (LTPA) during pregnancy and postpartum are lacking. While utilizing varying estimates of prepregnancy weight, we sought to prospectively examine associations among the aforementioned variables. Our sample consisted of a subset of women from the Archive for Research on Child Health Study (n = 68). Prepregnancy weight was obtained via questionnaire and birth certificates. GWG (2 estimates) was calculated by subtracting prepregnancy weight estimates from weight at delivery and classified as "excess" or "not excess." Pregnancy and postpartum LTPA were self-reported and dichotomized at recommended levels. Prepregnancy weight estimates were subtracted from self-reported postpartum weight to calculate 2 estimates of PPWR at 6 months. Linear regression was used to examine relationships among GWG and LTPA, and PPWR. Estimates of excess GWG were associated with increased PPWR (mean difference = 3.3-8.9 kg), even after adjustment for prepregnancy body mass index and breastfeeding. Meeting pregnancy and postpartum LTPA recommendations did not significantly predict PPWR. Our findings highlight the importance of encouraging appropriate GWG and provide insight into the impact varying estimates of prepregnancy weight may have when exploring associations among these variables.

The Stress-Metabolic Syndrome Relationship in Adolescents: An Examination of the Moderating Potential of Physical Activity.

BACKGROUND: The role of psychosocial stress in the development of obesity and metabolic syndrome is receiving increased attention and has led to examination of whether physical activity may moderate the stress-metabolic syndrome relationship. The current study examined relationships among physical activity, stress, and metabolic syndrome in adolescents. METHODS: Participants (N = 126; 57 girls, 69 boys) were assessed for anthropometry, psychosocial stress, physical activity, and metabolic syndrome variables; t tests were used to examine sex differences, and regression analysis was used to assess relationships among variables controlling for sex and maturity status. RESULTS: Mean body mass index approached the 75th percentile for both sexes. Typical sex differences were observed for systolic blood pressure, time spent in moderate and vigorous physical activity, and perceived stress. Although stress was not associated with MetS (ß = -.001, P = .82), a modest, positive relationship was observed with BMI (ß = .20, P = .04). CONCLUSIONS: Strong relationships between physical activity and stress with MetS or BMI were not found in this sample. Results may be partially explained by overall good physical health status of the participants. Additional research in groups exhibiting varying degrees of health is needed.

Demographic, cognitive, affective, and behavioral variables associated with overweight and obesity in low-active girls.

This study examined personal, cognitive, affective, and behavioral variables related to body mass index (BMI) among 73 6th and 7th grade girls, and differences between categories of healthy weight, overweight, and obese in the variables. BMI was correlated with barriers to physical activity, enjoyment of physical activity, light physical activity, moderate to vigorous physical activity, vigorous physical activity, and sedentary time. As compared to obese girls, those who were non-obese perceived greater enjoyment of physical activity, engaged in more light and vigorous physical activity, and had fewer minutes/hour of sedentary time. Findings can inform interventions.

Pilot intervention to increase physical activity among sedentary urban middle school girls: a two-group pretest-posttest quasi-experimental design.

The primary purpose of the study was to determine whether girls in one school receiving nurse counseling plus an after-school physical activity club showed greater improvement in physical activity, cardiovascular fitness, and body composition than girls assigned to an attention control condition in another school (N = 69). Linear regressions controlling for baseline measures showed no statistically significant group differences, but the directionality of differences was consistent with greater intervention group improvement for minutes of moderate to vigorous physical activity/hour (t = 0.95, p = .35), cardiovascular fitness (t = 1.26, p = .22), body mass index (BMI; t = -1.47, p = .15), BMI z score (t = -1.19, p = .24), BMI percentile (t = -0.59, p = .56), percentage body fat (t = -0.86, p = .39), and waist circumference (t = -0.19, p = .85). Findings support testing with a larger sample.

Treatment fidelity of motivational interviewing delivered by a school nurse to increase girls' physical activity.

Motivational interviewing, which involves the use of person-centered, directive counseling techniques, shows promise for changing adolescent behaviors. The purpose of this article was to describe the methodology and findings related to the treatment fidelity of three face-to-face motivational interviewing sessions involving middle school girls and a school nurse to help the girls increase their moderate-to-vigorous physical activity. The following four areas related to treatment fidelity were addressed: (a) study design, (b) training of interventionists, (c) intervention delivery, and (d) intervention receipt. Findings showed that 34 of 37 (91.9%) girls completed all three sessions. An initial motivational interviewing training workshop followed by evaluation of audiotaped sessions with constructive feedback can result in successful and consistent delivery by a school nurse.

Patient-level and hospital-level determinants of the quality of acute stroke care: a multilevel modeling approach.

BACKGROUND AND PURPOSE: Quality of care may be influenced by patient and hospital factors. Our goal was to use multilevel modeling to identify patient-level and hospital-level determinants of the quality of acute stroke care in a stroke registry. METHODS: During 2001 to 2002, data were collected for 4897 ischemic stroke and TIA admissions at 96 hospitals from 4 prototypes of the Paul Coverdell National Acute Stroke Registry. Duration of data collection varied between prototypes (range, 2-6 months). Compliance with 8 performance measures (recombinant tissue plasminogen activator treatment, antithrombotics < 24 hours, deep venous thrombosis prophylaxis, lipid testing, dysphagia screening, discharge antithrombotics, discharge anticoagulants, smoking cessation) was summarized in a composite opportunity score defined as the proportion of all needed care given. Multilevel linear regression analyses with hospital specified as a random effect were conducted. RESULTS: The average hospital composite score was 0.627. Hospitals accounted for a significant amount of variability (intraclass correlation = 0.18). Bed size was the only significant hospital-level variable; the mean composite score was 11% lower in small hospitals (≤ 145 beds) compared with large hospitals (≥ 500 beds). Significant patient-level variables included age, race, ambulatory status documentation, and neurologist involvement. However, these factors explained < 2.0% of the variability in care at the patient level. CONCLUSIONS: Multilevel modeling of registry data can help identify the relative importance of hospital-level and patient-level factors. Hospital-level factors accounted for 18% of total variation in the quality of care. Although the majority of variability in care occurred at the patient level, the model was able to explain only a small proportion.

Covariates of substance-use initiation for Venezuelan youth: using a multilevel approach to guide prevention programs.

OBJECTIVE: Illicit drug use in Latin America is on the rise. This study contributes to the literature by examining the extent five factors related to adolescent substance use among U.S. populations covary with age at first use in a sample of Venezuelan inner-city youth. METHOD: Anonymous self-administered questionnaires on drug involvement and related behaviors were administered to a cross-sectional sample of students, ages 11 to 18, drawn from 14 schools in two school districts in Caracas, Venezuela. A multilevel modeling approach investigated the relationship between age at first drug use reported by 1,514 students and three covariates (family attention, externalizing behavior, and peer drug use) and two control variables (gender and socioeconomic status). RESULTS: For the Level 1 within-schools covariates, family attention (t = 5.14, 1440 df, p < .001), and externalizing behavior (t = -4.61, 1440 df, p < .001) were significantly related to age at first use, and females initiated use later than did males (t = 2.51, 1440 df,p < .001). Peer drug use and socioeconomic status did not significantly covary with age at first use. At Level 2, the family attention slope varied across schools, chi(2)(13) = 24.14,p = .03. Additionally, mean school-level socioeconomic status (t = -7.22, 13 df, p < .001) explained most of the variance in average age at first use between schools and exerted a much stronger influence on age at first use than did family attention, externalizing behavior, or gender. CONCLUSIONS: Factors influencing substance initiation vary from the United States to Venezuela. Specific school cultures are stronger predictors of initiation than more proximal influences.

Using a Multivariate Multilevel Polytomous Item Response Theory Model to Study Parallel Processes of Change: The Dynamic Association Between Adolescents' Social Isolation and Engagement With Delinquent Peers in the National Youth Survey.

The application of multidimensional item response theory models to repeated observations has demonstrated great promise in developmental research. It allows researchers to take into consideration both the characteristics of item response and measurement error in longitudinal trajectory analysis, which improves the reliability and validity of the latent growth curve (LGC) model. The purpose of this study is to demonstrate the potential of Bayesian methods and the utility of a comprehensive modeling framework, the one combining a measurement model (e.g., a multidimensional graded response model, MGRM) with a structural model (e.g., an associative latent growth curve analysis, ALGC). All analyses are implemented in WinBUGS 1.4.3 ( Spiegelhalter, Thomas, Best, & Lunn, 2003 ), which allows researchers to use Markov chain Monte Carlo simulation methods to fit complex statistical models and circumvent intractable analytic or numerical integrations. The utility of this MGRM-ALGC modeling framework was investigated with both simulated and empirical data, and promising results were obtained. As the results indicate, being a flexible multivariate multilevel model, this MGRM-ALGC model not only produces item parameter estimates that are readily estimable and interpretable but also estimates the corresponding covariation in the developmental dimensions. In terms of substantive interpretation, as adolescents perceived themselves more socially isolated, the chance that they are engaged with delinquent peers becomes profoundly larger. Generally, boys have a higher initial exposure extent than girls. However, there is no gender difference associated with other latent growth parameters.

Athletes' evaluations of their head coach's coaching competency.

This study provided initial validity evidence for multidimensional measures of coaching competency derived from the Coaching Competency Scale (CCS). Data were collected from intercollegiate men's (n = 8) and women's (n = 13) soccer and women's ice hockey teams (n = 11). The total number of athletes was 585. Within teams, a multidimensional internal model was retained in which motivation, game strategy, technique, and character building comprised the dimensions of coaching competency. Some redundancy among the dimensions was observed. Internal reliabilities ranged from very good to excellent. Practical recommendations for the CCS are given in the Discussion section.

Extending validity evidence for multidimensional measures of coaching competency.

This study extended validity evidence for multidimensional measures of coaching competency derived from the Coaching Competency Scale (CCS; Myers, Feltz, Maier, Wolfe, & Reckase, 2006) by examining use of the original rating scale structure and testing how measures related to satisfaction with the head coach within teams and between teams. Motivation, game strategy, technique, and character building comprised the dimensions of coaching competency. Data were collected from athletes (N = 585) nested within intercollegiate men's (g = 8) and women's (g = 13) soccer and women's ice hockey (g = 11) teams (G = 32). Validity concerns were observed for the original rating scale structure and the predicted positive relationship between motivation competency and satisfaction with the coach between teams. Validity evidence was offered for a condensed post hoc rating scale and the predicted relationship between motivation competency and satisfaction with the coach within teams.