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1.
Health Educ Behav ; 48(6): 739-746, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34672834

RESUMO

BACKGROUND: African American (AA) women experience disproportionate levels of chronic disease, which is theorized to be driven by greater exposure to acute and chronic stress. The coronavirus (COVID-19) pandemic has further exacerbated existing health disparities among AA communities. Understanding how AA women have experienced and responded to stress during the pandemic may help to inform how future interventions can better address physical and mental well-being in AA communities. AIMS: Drawing from stress and coping models and an ecological framework, the present study conducted a theory-based qualitative assessment of stress-related experiences during the pandemic among a cohort of AA women, including (1) sources of stress, (2) coping strategies, (3) perceptions of health-related behaviors, (4) the role of community, and (5) recommendations for future interventions. METHOD: After completing a group-based physical activity intervention program during the COVID-19 pandemic, a cohort of AA women (N =17, Mage= 49.3 ± 11.24) completed individual interviews. Sessions were conducted by phone, audiotaped, transcribed, and coded by independent raters (rs = .71-.73). Themes were identified using deductive and inductive approaches. RESULTS: Among sources of stress directly related to the pandemic, being at home, getting sick, and homeschooling/parenting were the most frequently discussed themes. Participants engaged in active coping (problem and emotion-focused), with health behaviors, social support, and religion/spirituality, emerging as frequently discussed themes. Although some participants reported passive coping strategies (e.g., avoidance), this approach was less pronounced. CONCLUSIONS: These qualitative results are used to guide suggestions for future interventions that jointly address stress and health-related behaviors in order to improve translation of research into practice and policy for future pandemics and disasters.


Assuntos
COVID-19 , Pandemias , Adaptação Psicológica , Afro-Americanos , Feminino , Humanos , SARS-CoV-2
2.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34204927

RESUMO

This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child's weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = -0.331, SE = 0.162, p = 0.043), and concern (B = -0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.


Assuntos
Afro-Americanos/estatística & dados numéricos , Ingestão de Alimentos , Comportamento Alimentar , Pais/psicologia , Obesidade Pediátrica/etiologia , Adolescente , Afro-Americanos/psicologia , Bebidas Gaseificadas , Criança , Ingestão de Alimentos/etnologia , Ingestão de Alimentos/psicologia , Emoções , Ingestão de Energia , Comportamento Alimentar/etnologia , Comportamento Alimentar/psicologia , Feminino , Frutas , Humanos , Masculino , Obesidade Pediátrica/etnologia , Obesidade Pediátrica/psicologia , Inquéritos e Questionários , Verduras
3.
Nutrients ; 13(6)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34063799

RESUMO

Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child's weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent's weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.


Assuntos
Terapia Familiar/métodos , Refeições/psicologia , Poder Familiar/psicologia , Obesidade Pediátrica/terapia , Programas de Redução de Peso/métodos , Adolescente , Adulto , Afro-Americanos/psicologia , Dieta Saudável/etnologia , Dieta Saudável/psicologia , Comportamento Alimentar/etnologia , Comportamento Alimentar/psicologia , Feminino , Humanos , Masculino , Refeições/etnologia , Pessoa de Meia-Idade , Motivação , Análise Multinível , Relações Pais-Filho/etnologia , Obesidade Pediátrica/etnologia , Obesidade Pediátrica/psicologia , Avaliação de Programas e Projetos de Saúde
4.
J Behav Med ; 44(4): 541-550, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33751355

RESUMO

This study evaluated the associations between parenting factors and adolescent weight related outcomes in African American adolescents with overweight and obesity. Baseline heights and weights were collected from 241 African American adolescents (11-16 years) with overweight and obesity. Self-reported adolescent perceptions of caregiver's parenting style (responsiveness, demandingness), parental feeding practices (monitoring, responsibility, weight related concerns, pressure-to-eat, and restriction), and their own dietary self-efficacy for healthy eating were assessed. Results demonstrated that greater parental responsiveness was significantly associated with lower adolescent body mass index (BMI) and higher adolescent dietary self-efficacy. In contrast, parental concern about adolescent weight was significantly associated with greater adolescent BMI, while greater parental responsibility for foods was associated with lower adolescent BMI. Although parental pressure-to-eat was significantly associated with higher dietary self-efficacy, greater parental restriction was associated with lower dietary self-efficacy. The results of this study highlight the importance of parental responsiveness and responsibility in understanding obesity related outcomes in African American adolescents with overweight and obesity.


Assuntos
Afro-Americanos , Poder Familiar , Adolescente , Índice de Massa Corporal , Comportamento Alimentar , Humanos , Obesidade , Sobrepeso , Relações Pais-Filho , Inquéritos e Questionários
5.
J Behav Med ; 44(4): 563-570, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33768390

RESUMO

This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies.


Assuntos
Exercício Físico , Pobreza , Adolescente , Criança , Humanos , Pais , Características de Residência , Inquéritos e Questionários , Transportes
6.
J Pediatr Psychol ; 46(8): 980-990, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-33738484

RESUMO

OBJECTIVE: This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI. METHODS: Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention. RESULTS: Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI. CONCLUSIONS: These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.


Assuntos
Afro-Americanos , Poder Familiar , Adolescente , Índice de Massa Corporal , Comportamento Alimentar , Humanos , Relações Pais-Filho , Pais , Estresse Psicológico , Inquéritos e Questionários
7.
Ann Behav Med ; 55(8): 708-719, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32914830

RESUMO

BACKGROUND: Understanding determinants of metabolic risk has become a national priority given the increasingly high prevalence rate of this condition among U.S. adults. PURPOSE: This study's aim was to assess the impact of gene-by-neighborhood social environment interactions on waist circumference (WC) as a primary marker of metabolic risk in underserved African-American adults. Based on a dual-risk model, it was hypothesized that those with the highest genetic risk and who experienced negative neighborhood environment conditions would demonstrate higher WC than those with fewer risk factors. METHODS: This study utilized a subsample of participants from the Positive Action for Today's Health environmental intervention to improve access and safety for walking in higher-crime neighborhoods, who were willing to provide buccal swab samples for genotyping stress-related genetic pathways. Assessments were conducted with 228 African-American adults at baseline, 12, 18, and 24 months. RESULTS: Analyses indicated three significant gene-by-environment interactions on WC outcomes within the sympathetic nervous system (SNS) genetic pathway. Two interactions supported the dual-risk hypotheses, including the SNS genetic risk-by-neighborhood social life interaction (b = -0.11, t(618) = -2.02, p = .04), and SNS genetic risk-by-informal social control interaction (b = -0.51, t(618) = -1.95, p = .05) on WC outcomes. These interactions indicated that higher genetic risk and lower social-environmental supports were associated with higher WC. There was also one significant SNS genetic risk-by-neighborhood satisfaction interaction (b = 1.48, t(618) = 2.23, p = .02) on WC that was inconsistent with the dual-risk pattern. CONCLUSIONS: Findings indicate that neighborhood and genetic factors dually influence metabolic risk and that these relations may be complex and warrant further study. TRIAL REGISTRATION: NCT01025726.

8.
Ann Behav Med ; 55(4): 376-382, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-32692356

RESUMO

BACKGROUND: African American women participate in less physical activity (PA), have higher rates of chronic disease, and report higher perceived stress relative to other race and sex demographic groups. PURPOSE: Based on the stress-buffering hypothesis, this study tested the hypothesis that social support would buffer the negative effects of perceived stress on moderate-to-vigorous PA (MVPA) under high, but not low, perceived stress. METHODS: Participants were 143 African American women (mean [M] age = 43.94, standard deviation [SD] = 8.62; M body mass index = 37.94, SD = 8.11) enrolled in the Families Improving Together (FIT) for Weight Loss Trial. Average daily minutes of MVPA were obtained via 7 day accelerometer estimates at baseline and 8 and 16 weeks. RESULTS: A multilevel growth model demonstrated a significant three-way interaction between stress, social support, and time (B = -0.31, standard error [SE] = 0.14, p = .03). Simple slopes analyses revealed that, at baseline, among participants with high social support (+1 SD), stress was positively associated with greater MVPA (B = 0.49, SE = 0.18, p = .008), whereas among participants with low social support (-1 SD), stress was not significantly associated with MVPA (B = -0.04, SE = 0.14, p = .81). However, at 8 and 16 weeks, stress was not significantly associated with MVPA for either high or low support groups. CONCLUSIONS: Findings highlight the importance of integrating constructs of stress and social support into future physical activity intervention programs for African American women and the need to evaluate changes in stress and social support longitudinally.

9.
Health Promot Pract ; : 1524839920939572, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32639170

RESUMO

Background. The purpose of the current article is to demonstrate how formative process evaluation was used in a pilot study to optimize the design and implementation of two motivationally targeted community-based physical activity (PA) interventions for inactive African American women. Method. Fifteen African American women (M age: 41.6 years) were randomized to a challenge-focused program targeted toward high autonomous motivation or a rewards-focused program targeted toward low autonomous motivation. The challenge-focused program targeted enjoyment and valuation of PA and a team-based positive social climate through competitive intergroup activities and team-based goals, whereas the rewards-focused program targeted PA interest, competency, and partner-based social support through a walking program, individual-based goals with financial incentives, and partner-based action-plans. Results. Feedback from participants revealed high levels of acceptability of essential elements. Average weekly attendance exceeded the a priori goal of ≥75% of members in attendance each week. External systematic observation demonstrated that session content dose was ≥93% in both programs. Facilitator-level fidelity exceeded the a priori goal of averaging ≥3 on a 4-point scale for behavioral skills, communication, autonomy support, and session content. The process evaluation also revealed areas for improvement, including facilitator-level social support and behavioral skills at the group-level. Process data collected through FitBits revealed that participants were engaged in self-monitoring PA during the 6-week programs. Conclusions. The formative process evaluation demonstrated adequate levels of feasibility and acceptability and also provided key insights into adjustments needed before proceeding with implementing the motivationally targeted group-based programs in a larger randomized study.

10.
mBio ; 11(4)2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665276

RESUMO

Inteins, as posttranslational regulatory elements, can tune protein function to environmental changes by conditional protein splicing (CPS). Translated as subdomains interrupting host proteins, inteins splice to scarlessly join flanking sequences (exteins). We used DnaB-intein1 (DnaBi1) from a replicative helicase of Mycobacterium smegmatis to build a kanamycin intein splicing reporter (KISR) that links splicing of DnaBi1 to kanamycin resistance. Using expression in heterologous Escherichia coli, we observed phenotypic classes of various levels of splicing-dependent resistance (SDR) and related these to the insertion position of DnaBi1 within the kanamycin resistance protein (KanR). The KanR-DnaBi1 construct demonstrating the most stringent SDR was used to probe for CPS of DnaB in the native host environment, M. smegmatis We show here that zinc, important during mycobacterial pathogenesis, inhibits DnaB splicing in M. smegmatis Using an in vitro reporter system, we demonstrated that zinc potently and reversibly inhibited DnaBi1 splicing, as well as splicing of a comparable intein from Mycobacterium leprae Finally, in a 1.95 Å crystal structure, we show that zinc inhibits splicing through binding to the very cysteine that initiates the splicing reaction. Together, our results provide compelling support for a model whereby mycobacterial DnaB protein splicing, and thus DNA replication, is responsive to environmental zinc.IMPORTANCE Inteins are present in a large fraction of prokaryotes and localize within conserved proteins, including the mycobacterial replicative helicase DnaB. In addition to their extensive protein engineering applications, inteins have emerged as environmentally responsive posttranslational regulators of the genes that encode them. While several studies have shown compelling evidence of conditional protein splicing (CPS), examination of splicing in the native host of the intein has proven to be challenging. Here, we demonstrated through a number of measures, including the use of a splicing-dependent sensor capable of monitoring intein activity in the native host, that zinc is a potent and reversible inhibitor of mycobacterial DnaB splicing. This work also expands our knowledge of site selection for intein insertion within nonnative proteins, demonstrating that splicing-dependent host protein activation correlates with proximity to the active site. Additionally, we surmise that splicing regulation by zinc has mycobacteriocidal and CPS application potential.


Assuntos
DnaB Helicases/antagonistas & inibidores , Mycobacterium/efeitos dos fármacos , Processamento de Proteína/efeitos dos fármacos , Zinco/farmacologia , Proteínas de Bactérias/antagonistas & inibidores , Proteínas de Bactérias/genética , DnaB Helicases/química , DnaB Helicases/genética , Escherichia coli/genética , Inteínas/genética , Mycobacterium/enzimologia , Mycobacterium/genética , Processamento de Proteína Pós-Traducional
11.
Eval Program Plann ; 77: 101718, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31539644

RESUMO

Self-Determination Theory proposes that some people are motivated to initiate physical activity by externally-controlled reasons (e.g., physical appearance, approval from others), whereas others feel compelled by more autonomous sources of motivation (e.g., enjoyment, personal importance). This study used qualitative methods to examine whether individual differences in autonomous motivation offers a useful framework for developing targeted intervention programs for African American women. Focus groups (k = 6) were conducted to examine how different levels of autonomous motivation for physical activity related to differences in physical activity barriers and facilitators among African American women (N = 31). Sessions were audiotaped, transcribed, and coded by independent raters (r = 0.70). QSR NVivo 11 was used to analyze data, and themes were identified separately for women with low, medium, or high autonomous motivation. Those with high autonomous motivation focused on themes of wanting novelty, excitement, and competition, whereas those with low autonomous motivation focused on themes of wanting instrumental support and financial incentives for increasing engagement in physical activity. Implications for developing physical activity intervention programs for African American women that are targeted toward differences in autonomous motivation are discussed.


Assuntos
Afro-Americanos/psicologia , Exercício Físico/psicologia , Promoção da Saúde/métodos , Motivação , Adulto , Idoso , Comportamento Competitivo , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Desenvolvimento de Programas , Pesquisa Qualitativa , Adulto Jovem
12.
Health Psychol ; 38(8): 689-700, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368753

RESUMO

This paper examines three distinct examples of interventions in nonclinical settings selected to highlight the challenges and opportunities for evaluating cost-effectiveness in the field of health psychology and behavioral medicine. Nonclinical settings are defined as those involving systems outside of traditional medical/clinical settings, and include interventions tested in clinical settings that can also be implemented in nonclinical settings. The examples in this paper reflect the use of a varying degree of existing cost-effectiveness data and previous health economic analyses. First, the Chronic Disease Self-Management Program model reflects an intervention protocol designed to increase patients' confidence and mastery in their ability to manage their conditions that has been shown to be cost effective for a variety of chronic disease conditions. Second, the cost and cost-effectiveness of tobacco quitlines (e.g., National Tobacco Quit Line) has been the subject of several preliminary cost-effectiveness examinations and has proven to have significant reach and impact on tobacco-related behaviors. Finally, environmental interventions for promoting walking and physical activity in community-based contexts (e.g., PATH trial) are presented and have been shown to be highly relevant for demonstrating cost-effectiveness. Overall, the disciplines of health psychology and behavioral medicine are in a unique position to develop, implement, and evaluate a broader range of interventions in more diverse environments than cost-effectiveness applications in more traditional, clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Comportamental/economia , Análise Custo-Benefício/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Humanos
13.
Am J Mens Health ; 13(3): 1557988319855155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31148501

RESUMO

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today's Health (PATH) trial. African American men ( n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA ( B = 1.15, SE = .41, p = .006). Exercise attitudes ( B = .16, SE = .07, p = .037), exercise self-concept ( B = .28, SE = .06, p < .001), exercise support from friends ( B = .12, SE = .06, p = .048), and places for walking and cycling ( B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men. ClinicalTrials.gov # NCT01025726.


Assuntos
Afro-Americanos , Exercício Físico , Motivação , Atitude Frente a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Características de Residência , Segurança , Autoeficácia , Meio Social , Apoio Social , South Carolina
14.
Int J Behav Nutr Phys Act ; 16(1): 47, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31126345

RESUMO

BACKGROUND: Although weight loss is an important primary outcome in obesity interventions, family-based interventions may have cascading ripple effects that extend to other aspects of health and well-being. Identifying these secondary benefits may be useful for understanding how to best engage underserved African American families in weight loss. The present research examines whether African American adolescents and parents perceive secondary benefits from participating in a family-based weight-loss intervention, including secondary health, social, or cognitive benefits. METHODS: Qualitative data were obtained from families participating in the group-based intervention of the Families Improving Together (FIT) for Weight Loss trial. During the final week of the face-to-face motivational and family-based intervention program, families completed a guided open-ended group discussion about changes they experienced from participating (14 groups, N = 41 adolescents and 41 parents). Sessions were audiotaped, transcribed, and coded by independent pairs of raters using both inductive and deductive approaches. Guided by the multi-theoretical framework for the FIT trial, some themes were determined prior to coding using a deductive approach, including: (a) health outcomes (e.g., monitoring strategies for diet and physical activity), (b) social outcomes (e.g., involvement in family support, group support, autonomy support, family bonding, positive communication) and (c) cognitive outcomes (e.g., expression of self-confidence through self-efficacy, self-regulation, establishment of long-term goals). In addition to these pre-determined themes, the coding process included an inductive assessment, allowing for unexpected themes to surface as well around positive self-talk, relapse prevention, and monitoring strategies for different types of weight-related behaviors. RESULTS: Across both adolescents and parents, the cognitive outcomes were the most frequently discussed outcomes, including self-regulation, monitoring strategies for diet, establishing long-term goals, and ultimate relapse prevention. Parents made a greater number of comments about the social outcomes, including family support, group support, self-efficacy, and family connectedness, whereas adolescents made a greater number of comments about positive family communication. CONCLUSIONS: The results provide preliminary support for the positive secondary effects of weight loss programs on improving both cognitive and social well-being in underserved African American adolescents. TRIAL REGISTRATION: ClinicalTrials.gov # NCT01796067. https://clinicaltrials.gov/ct2/show/NCT01796067?term=NCT01796067&rank=1 The trial was registered on February 21, 2013 and the first participant was enrolled July 12, 2013.


Assuntos
Afro-Americanos/psicologia , Família/psicologia , Perda de Peso/fisiologia , Programas de Redução de Peso , Adolescente , Humanos , Autoeficácia , Apoio Social
15.
Ann Behav Med ; 53(4): 399-404, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30892641

RESUMO

BACKGROUND: Interventions that incorporate behavioral skills training and parental involvement have been effective for promoting weight loss among middle and upper class youth; however, few studies have produced similar weight loss effects in underserved ethnic minority youth. PURPOSE: This study examined whether online program exposure (in both an online tailored intervention and an online health education comparison program) predicted greater retention among African American youth and their parents in the Families Improving Together (FIT) for Weight Loss trial. METHODS: Parent-adolescent dyads (N = 125) were randomized to either an online tailored intervention program (n = 63) or an online health education comparison program (n = 62). Paradata including login data were used to determine the number of sessions viewed (0-8) and the number of minutes spent online per session. Study retention, defined as collection of adolescent anthropometric measures at 6 months postintervention, was the outcome. RESULTS: Logistic regression analyses showed a significant effect for login rate on retention (OR = 1.21, 95% CI [1.04, 1.39]). Total number of sessions viewed, child age, child sex, parent age, and parent sex accounted for 11% of the variance in retention at 6 months post- intervention. Participants who were retained spent a significantly greater number of minutes during each session (M = 12.99, SD = 11.63) than participants who were not retained (M = 7.77, SD = 11.19), t(123) = 2.24, p = .027, d = 0.45. CONCLUSIONS: The use of paradata from online interventions is a novel and feasible approach for examining exposure in web-based interventions and program retention in underserved ethnic minority families. TRIAL REGISTRATION: ClinicalTrials.gov NCT01796067. Registered January 23, 2013.


Assuntos
Terapia Comportamental , Internet , Sobrepeso/terapia , Perda de Peso/fisiologia , Programas de Redução de Peso , Adolescente , Afro-Americanos , Criança , Família , Feminino , Humanos , Masculino , Sobrepeso/psicologia , Pais , Avaliação de Programas e Projetos de Saúde
16.
Med Clin North Am ; 102(1): 125-133, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29156180

RESUMO

Behavioral medicine provides a framework for supporting patients to achieve changes in target health behaviors, such as dietary and physical activity changes. Behavioral medicine fits alongside traditional medical treatments, can minimize the need for more intensive medical treatments, improves outcomes of these treatments, and improves adherence to medication prescriptions or postsurgical recommendations. This article provides an overview of behavioral medicine counseling for obesity in primary care, rooted in the "5 As" approach to health behavior change, and the basic outline of behavioral skills interventions in which health care providers use self-regulatory and behavioral strategies to improve health-related behaviors among patients with obesity.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Obesidade/terapia , Educação de Pacientes como Assunto/organização & administração , Atenção Primária à Saúde/organização & administração , Aconselhamento , Estilo de Vida Saudável , Humanos , Relações Profissional-Paciente
17.
Int J Behav Nutr Phys Act ; 14(1): 67, 2017 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28532489

RESUMO

BACKGROUND: Engaging in regular physical activity (PA) as an older adult has been associated with numerous physical and mental health benefits. The aim of this study is to directly compare how individual-level cognitive factors (self-efficacy for PA, self-determined motivation for PA, self-concept for PA) and neighborhood perceptions of the social factors (neighborhood satisfaction, neighborhood social life) impact moderate-to-vigorous physical activity (MVPA) longitudinally among older African American adults. METHODS: Data were analyzed from a sub-set of older African American adults (N = 224, M age = 63.23 years, SD = 8.74, 63.23% female, M Body Mass Index = 32.01, SD = 7.52) enrolled in the Positive Action for Today's Health trial. MVPA was assessed using 7-day accelerometry-estimates and psychosocial data (self-efficacy for PA, self-determined motivation for PA, self-concept for PA, neighborhood satisfaction, neighborhood social life) were collected at baseline, 12-, 18-, and 24-months. RESULTS: Multilevel growth modeling was used to examine within- and between-person effects of individual-level cognitive and social environmental factors on MVPA. At the between-person level, self-concept (b = 0.872, SE = 0.239, p < 0.001), and neighborhood social life (b = 0.826, SE = 0.176, p < 0.001) predicted greater MVPA, whereas neighborhood satisfaction predicted lower MVPA (b = -0.422, SE = 0.172, p = 0.015). Among the between-person effects, only average social life was moderated by time (b = 0.361, SE = 0.147, p = 0.014), indicating that the impact of a relatively positive social life on MVPA increased across time. At the within-person level, positive increases in self-concept (b = 0.294, SE = 0.145, p = 0.043) and neighborhood social life (b = 0.270, SE = 0.113, p = 0.017) were associated with increased MVPA. CONCLUSIONS: These results suggest that people with a higher average self-concept for PA and a more positive social life engaged in greater average MVPA. Additionally, changes in perceptions of one's neighborhood social life and one's self-concept for PA were associated with greater MVPA over 2 years. These factors may be particularly relevant for future interventions targeting long-term change and maintenance of MVPA in older African Americans. TRIAL REGISTRATION: ClinicalTrials.Gov # NCT01025726 registered 1 December 2009.


Assuntos
Afro-Americanos , Exercício Físico , Características de Residência , Autoeficácia , Meio Social , Acelerometria , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Atividade Motora
18.
Clin Child Fam Psychol Rev ; 20(1): 64-77, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28229248

RESUMO

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth's behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.


Assuntos
Poder Familiar/psicologia , Obesidade Pediátrica/prevenção & controle , Características de Residência , Instituições Acadêmicas , Meio Social , Apoio Social , Adolescente , Criança , Humanos
19.
Appetite ; 112: 272-285, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28188866

RESUMO

OBJECTIVE: The present study aimed to quantify the magnitude of the association between future temporal perspective and Body Mass Index (BMI), diet, and exercise, respectively, and to clarify whether subjective future-focus scales or delay-discounting tasks are a more robust predictor of health behaviors. METHODS: A systematic search was conducted for studies that included a dispositional measure of future temporal perspective and a measure of BMI, eating, and/or exercise behavior. Effect sizes for BMI, eating, and exercise were calculated using a random-effects model. RESULTS: The aggregate effect sizes for BMI (r = 0.14, k = 36, 95% CI = 0.10 - 0.18, p < 0.001), eating (r = 0.16, k = 18, 95% CI = 0.12-0.21, p < 0.001), and exercise (r = 0.12, k = 18, 95% CI = 0.09-0.14, p < 0.001) were significant and small in magnitude. Neither the type of future temporal perspective task (delay-discounting vs. subjective future-focus scale) nor the percentage of obese participants moderated the effect of temporal perspective on BMI, eating, or exercise. CONCLUSIONS: Although small in magnitude, the association between temporal perspective and health outcomes is comparable to other individual differences, such as personality and temperament. Future research is needed to examine how increasing the value placed on future outcomes can be integrated into long-term health behavior change interventions.


Assuntos
Índice de Massa Corporal , Desvalorização pelo Atraso , Dieta , Exercício Físico/psicologia , Comportamento Alimentar/psicologia , Comportamentos Relacionados com a Saúde , Obesidade/psicologia , Adolescente , Adulto , Idoso , Ingestão de Alimentos , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Health Psychol ; 34(2): 149-59, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25089345

RESUMO

OBJECTIVE: The present study aimed to quantify the magnitude of the effect of self-affirmation manipulations on health messages' influence on both intentions and behavior. METHODS: A systematic search was conducted for experimental studies comparing participants who self-affirmed prior to reading a threatening health message to those who did not self-affirm. Effect sizes for health intentions and behaviors were aggregated using a random-effects model. RESULTS: Data from 16 studies were included. The aggregate effect sizes for intentions and behavior were significant and small in magnitude (d+ = .26, 95% confidence interval [CI] = .04-.48; d+ = .27, 95% CI = .11-.43, respectively). A meta-regression analysis revealed that among studies assessing both outcomes, the size of an effect on intentions did not predict the size of an effect on behavior, ß = .03, 95% CI = -.30-.36. Type of health behavior (damaging vs. promoting), timing of the health behavior (proximal vs. distal), type of self-affirmation manipulation (values vs. kindness), and the specificity of the health message (single vs. multiple health issues) did not moderate the effect of self-affirmation on intentions or behavior. CONCLUSIONS: Self-affirmation influences health messages' effect on intentions and behavior; however, with the present study finding that intention effect sizes did not predict behavior effect sizes, and with past studies of heath behavior change finding that intentions do not always translate to behavior, little research supports a causal intention-behavior relation among self-affirmation studies. Future research is needed to address which specific health-related responses explain why self-affirmation elicits health behavior change.


Assuntos
Comportamentos Relacionados com a Saúde , Comunicação em Saúde , Promoção da Saúde , Intenção , Atitude Frente a Saúde , Humanos
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