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.

Interactions between individual and perceived environmental factors on Latinas' physical activity.

Background: Latinas have disproportionately low levels of physical activity (PA) and the ecological correlates of their PA remain unclear. This study aims to test interactions between individual and environmental factors on Latinas' PA. Methods: We analyzed baseline data from 436 Latinas participating in a PA randomized controlled trial in San Diego, CA [Fe en Acción/Faith in Action]. Measures included demographics, perceived environment, PA and anthropometrics. Mixed effects models examined interactions between individual and environmental factors on self-reported leisure-time and transportation, and accelerometer-assessed PA. Results: Significant positive associations were found between neighborhood aesthetics and leisure-time moderate-to-vigorous PA (MVPA) and between having destinations within walking distance from home and transportation PA (P < 0.05). We found significant interactions of income with aesthetics and sidewalk maintenance as well as between weight status and safety from crime. Favorable aesthetics was related to more leisure-time MVPA only among lower income women (odds ratio (OR) = 1.57; 95% confidence interval (CI): 1.18, 2.08); however, higher income women reporting better sidewalk maintenance reported more leisure-time MVPA (OR = 1.51; 95% CI: 1.06, 2.15). Higher perceived safety from crime was positively related to transportation PA only among overweight/obese women. Conclusions: Subgroup differences should be considered when developing interventions targeting the neighborhood environment to promote Latinas' PA.

Promoting cancer screening among churchgoing Latinas: Fe en Acción/faith in action.

Cancer screening rates among Latinas are generally low, reducing the likelihood of early cancer detection in this population. This article examines the effects of a community intervention (Fe en Acción/Faith in Action) led by community health workers (promotoras) on promoting breast, cervical and colorectal cancer screening among churchgoing Latinas. Sixteen churches were randomly assigned to a cancer screening or a physical activity intervention. We examined cancer knowledge, barriers to screening and self-reported mammography, clinical breast exam, Pap test, fecal occult blood test and sigmoidoscopy or colonoscopy at baseline and 12 months follow-up. Participants were 436 adult Latinas, with 16 promotoras conducting a cancer screening intervention at 8 out of 16 churches. The cancer screening intervention had a significant positive impact on self-reported mammography (OR = 4.64, 95% CI: 2.00-10.75) and breast exams in the last year (OR= 2.82, 95% CI: 1.41-5.57) and corresponding reductions in perceived (87.6%) barriers to breast cancer screening (P < .008). Cervical and colorectal cancer screening did not improve with the intervention. These findings suggest Fe en Acción church-based promotoras had a significant impact on promoting breast cancer screening among Latinas. Colon cancer screening promotion, however, remains a challenge.

Trait anger, cynical hostility and inflammation in Latinas: variations by anger type?

Anger and hostility are psychological factors that appear to play a salient role in relation to cardiovascular disease (CVD) risk; however, their association with risk within the Latino population remains relatively unexplored. The current study examined associations between overall trait anger, anger subdimensions (i.e., anger temperament and anger reaction) and cynical hostility with sICAM-1, a marker of cellular adhesion and systemic inflammation related to CVD risk, in a sample of 294 middleaged Mexican-American women. Results showed no association between trait anger or anger temperament and sICAM-1. Anger reaction was marginally associated with sICAM-1 (ß=4.77, p=.06). Cynical hostility was significantly associated with sICAM-1 (ß=5.89, p=.04) even after controlling for demographic, biological and behavioral covariates. The current study provides evidence that specific aspects of anger and hostility relate to physiological pathways that potentially influence CVD risk. Findings are discussed in light of contextual cultural factors.

Perceived Neighborhood Environmental Factors That Maximize the Effectiveness of a Multilevel Intervention Promoting Physical Activity Among Latinas.

PURPOSE: This study tested whether a multilevel physical activity (PA) intervention had differential effects on PA according to participants' perceptions of their neighborhood environment. DESIGN: Two-group cluster randomized controlled trial. SETTING: San Diego, California. SUBJECTS: Analytical sample included 319 Latinas (18-65 years) from churches randomized to the following conditions: PA (n = 8 churches, n = 157 participants) or attention control (n = 8 churches, n = 162 participants). INTERVENTION: Over 12 months, PA participants were offered free PA classes (6/wk), while attention control participants were offered cancer prevention workshops. MEASURES: Baseline and 12-month follow-up measures included self-report and accelerometer-based moderate to vigorous physical activity (MVPA), sociodemographics, and perceived neighborhood environment variables. ANALYSIS: Mixed-effects models examined each PA outcome at 12-month follow-up, adjusted for church clustering, baseline PA, and sociodemographics. We tested interactions between 7 baseline perceived environment variables and study condition. RESULTS: Neighborhood esthetics was the only significant moderator of intervention effects on accelerometer-based MVPA and self-report leisure-time MVPA. Participants in the PA intervention had significantly higher PA at follow-up than attention control participants, only when participants evaluated their neighborhood esthetics favorably. CONCLUSION: Perceived neighborhood esthetics appeared to maximize the effectiveness of a multilevel PA intervention among Latinas. For sustainable PA behavior change, the environments in which Latinas are encouraged to be active may need to be evaluated prior to implementing an intervention to ensure they support active lifestyles.

Socio-demographic Moderators of Associations Between Psychological Factors and Latinas' Breast Cancer Screening Behaviors.

This study tested whether socio-demographic factors moderated associations between psychological factors and Latinas' breast cancer screening behaviors. 222 churchgoing Latinas (40-65 years) in San Diego, CA completed surveys assessing socio-demographics (e.g., income and acculturation), psychological factors (e.g., perceived barriers to screening), and cancer screening behaviors. Multilevel models examined associations of socio-demographic and psychological factors (and their interactions) with adherence to annual mammography or clinical breast exam (CBE) screening. Although no main effects were found, there were moderation effects. Acculturation moderated associations between perceived barriers to screening and both screening outcomes, with inverse associations only among the high-acculturation group. Education moderated the relationship between perceived barriers to screening and CBE screening, with an inverse association only among the low-education group. Marital status moderated the relationship between depressive symptoms and CBE screening, with an inverse association only among single/non-partnered participants. Interventions are needed targeting psychological barriers to breast cancer screening among Latinas.

A randomized controlled trial to prevent obesity among Latino paediatric patients.

BACKGROUND: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic-based approaches in this population. OBJECTIVE: The purpose of this study was to test the efficacy of a clinic-based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. METHODS: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5-10 years old) and their parents. The 12-month family-based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid-level providers. The primary study outcome was child BMI (kg m-2 ) assessed at baseline, 6-month (n = 191) and 12-month (n = 201) post-baseline. A subsample of the children was examined for overall and site-specific adiposity using dual-energy X-ray absorptiometry (n = 79). RESULTS: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. CONCLUSIONS: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families.

Does the social environment moderate associations of the built environment with Latinas' objectively-measured neighborhood outdoor physical activity?

Favorable perceptions of the built and social neighborhood environment may promote outdoor physical activity (PA). However, little is known about their independent and interactive effects on neighborhood-specific outdoor PA. We examined associations of perceived built and social neighborhood environment factors, and their interactions, with objectively-measured neighborhood outdoor moderate-to-vigorous physical activity (MVPA) among a sample of Latina women in San Diego, CA. Analyses included baseline data collected in 2011-2013 from 86 Latinas with ≥ 2 days of combined accelerometer and global positioning system data and complete survey measures. We examined objective neighborhood outdoor MVPA within 500-meter home buffers. Generalized linear mixed models examined associations of 3 perceived built (e.g., sidewalk maintenance) and 3 social environmental (e.g., safety from crime) factors with engaging in any daily neighborhood outdoor MVPA. Models tested interactions between the built and social environmental factors. Although the perceived neighborhood environmental factors were not significantly related to daily neighborhood outdoor MVPA, we found 2 significant interactions: perceived sidewalk maintenance x safety from crime (p = 0.05) and neighborhood aesthetics x neighborhood social cohesion (p = 0.03). Sidewalk maintenance was positively related to daily neighborhood outdoor MVPA only among Latinas that reported low levels of safety from crime. Neighborhood aesthetics was positively related to daily neighborhood outdoor MVPA only among Latinas with high neighborhood social cohesion. Findings suggest several built and social environmental factors interact to influence Latinas' neighborhood outdoor MVPA. Interventions are needed targeting both built and social neighborhood environmental factors favorable to outdoor PA in the neighborhood.

Role of cigarette smoking as a gateway drug to alcohol use in Hispanic junior high school students.

BACKGROUND: Many studies have examined predictors of alcohol and other substance use in adolescents, but few have looked specifically at Hispanic adolescents in their junior high school years. PURPOSE: The purpose of this study was to explore the extent to which tobacco use may contribute as a gateway drug for subsequent alcohol use among Hispanic adolescents in San Diego, Calif. METHODS: A multiple regression procedure was used to test if 7th-grade to 9th-grade change in smoking status predicted 9th-grade alcohol use while controlling for a variety of other variables. RESULTS: Among the variables analyzed, increased level of smoking was the strongest predictor of subsequent 9th-grade alcohol use, followed by stronger intentions to drink, female sex, and having grades below a "C." CONCLUSION: 7th- to 9th-grade smoking change is highly predictive of subsequent alcohol use. IMPLICATIONS: The study findings suggest that preventive intervention for alcohol use among Hispanic adolescents should focus on changes in smoking status as a significant risk factor and should examine the role of acculturation and other variations that make this population different from other U.S. subgroups.

Item non-response to lifestyle assessment in an elderly cohort.

BACKGROUND: Greater attention is being paid to data quality in surveys of older age groups. In this paper patterns of item non-response are examined in a health risk appraisal instrument administered to an elderly cohort participating in a randomized preventive intervention study. METHODS: The association between demographic and health status factors with the number of non-responses out of 174 items was examined at baseline and at the 12-month follow-up on 1791 subjects. RESULTS: Overall, non-response decreased from baseline to 12 months. The pattern was consistent across the seven major components of the questionnaire. Univariate analyses at baseline found that item non-response increased significantly (P < 0.05) with age, being female, being unmarried, lower annual income, less education, and poorer personal health ranking. Polychotomous logistic regression identified age and personal health ranking as statistically significant at both baseline and 12-month follow-up assessments after controlling for all other factors. In addition, education was significant at baseline. CONCLUSIONS: These results help to identify subgroups of elderly participants who contribute to non-random patterns of missing data.

Determinants of non-compliance and attrition in the elderly.

BACKGROUND: This report identifies demographic and health-related baseline factors associated with non-compliance and attrition in elderly subjects participating in a preventive intervention study over a 4-year follow-up period. METHODS: The Cox proportional hazards model and polychotomous logistic regression were used to evaluate time to clinic assessment non-compliance and type of non-participation. RESULTS: Of 1785 subjects, 35.6 percent were non-compliant during follow-up which meant they were eligible to participate at the time they were contacted but would not or could not return for an assessment. Refusals due to a lack of continuing interest or being too busy,and those citing health problems constituted the major subgroups of non-compliers. Death, unable to contact, and ineligible due to disenrollment or moving away accounted for nearly 20 percent. Four-year compliance was achieved by 44.4 percent of the participants. Time to non-compliance was significantly shorter with older age, lower annual income, poorer personal health ranking, and, to a marginal extent, depression. Lower annual income was associated with all reasons for non-participation including disenrollment or moving. Other factors correlated with specific types of nonparticipation. CONCLUSIONS: These results can be useful in designing more effective cohort maintenance strategies. Greater resources may be allocated to subgroups who are less likely to continue.

Compliance with a 12-month assessment in an elderly cohort participating in a preventive intervention study: the San Diego Medicare Preventive Health Project.

Non-compliance in long-term cohort studies contributes to bias in the estimation of study parameters and loss of power in hypothesis testing. This paper identifies baseline factors associated with non-compliance in a 12-month health assessment among elderly participants in the San Diego Medicare Preventive Health Project, a randomized preventive intervention study. A non-complier was defined as a study subject contacted by telephone by study personnel to schedule an appointment for the 12-month health assessment but who would not or could not attend. Of the almost 1600 contacted subjects, 14.1% did not participate in the evaluation. Using logistic regression, non-compliance was found to be associated with older age, intervention group assignment, nonsingle family residence, no alcohol use, and, to a lesser extent, depression. No interactions between group assignment and other baseline factors were detected. These results may be useful in designing cohort maintenance strategies where greater resources may be devoted to participants at higher risk of non-compliance and attrition.

Factors parents use in selecting play spaces for young children.

BACKGROUND: The amount of time children spend in play spaces (ie, physical locations that are appropriate for children's physical activity) near their homes is correlated with their level of physical activity. OBJECTIVE: To examine factors used in parents' decisions about the selection of play spaces for their children. SUBJECTS: Parents (primarily mothers) of 178 Mexican American and 122 white children who were a mean age of 4.9 years old at the first measurement. MEASURES: In individual interviews, parents rated 24 factors on their importance in selecting for their children a play space that is away from their home or yard. Decision factors were rated from 1 (ie, not important at all) to 5 (ie, very important). RESULTS: The most important factors, with ratings ranging from 4.8 to 4.2, were safety and availability of toilets, drinking water, lighting, and shade. Mexican American parents rated 8 of 24 items significantly higher than did white parents, including lighted at night, organized activities, play supplies, and drinking water. White parents rated 5 of 24 items significantly higher than did Mexican American parents, including distance from home, cost of admission, and child's friends go there. The rated importance of 7 of 24 items increased during 1 year, including play supplies, drinking water, distance from home, and parents' friends or relatives go there. CONCLUSIONS: These results indicate that parents can identify factors they use in selecting places for their young children to play, and selection factors differ somewhat by ethnicity or socioeconomic status. Further studies are needed to determine whether improvements on the most important selection factors might be effective in increasing the use of play spaces by children and their parents. Clinicians may be able to use the most highly rated decision factors to help parents assess the acceptability of play spaces in their areas.

Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health.

OBJECTIVE: To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. DESIGN: Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. PARTICIPANTS: We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. RESULTS: Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P<.001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P = .01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. CONCLUSION: The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors.

Theories and intervention approaches to health-behavior change in primary care.

CONTENT: Providers typically rely on health information and their professional status to convince patients to change. Health-behavior theories and models suggest more effective methods for accomplishing patient compliance and other behavior change related to treatment regimens. Behavior modification stresses the remediation of skill deficits or using positive and negative reinforcement to modify performance. Like behavior modification, the Health Belief Model stresses a reduction of environmental barriers to behavior. Social Learning Theory suggests that perceptions of skills and reinforcement may more directly determine behavior. Self-management models put the above theories into self-change actions. Social support theories prioritize reinforcement delivered through social networks, whereas the Theory of Reasoned Action emphasizes perceptions of social processes. Finally, the Transtheoretical Model speaks of the necessity to match interventions to cognitive-behavioral stages. Strategies derived from each of these theories are suggested herein.

Correlates of compliance with measurement protocols in a Latino nutrition-intervention study.

INTRODUCTION: It is well known that attrition and noncompliance in longitudinal health intervention studies contribute to bias in both internal and external validity. However, little is known about rates and correlates of compliance with measurement protocols among Latinos. This article investigates correlates of compliance with follow-up physical measurement protocols among Latino subjects in a nutrition-oriented cardiovascular disease prevention program targeting low-English literate adults. METHODS: Correlates of compliance, measured at baseline, included four classes of variables: demographic characteristics, physical measures, health behaviors, and nutrition-related psychological variables. Subjects were categorized into one of three compliance groups: on-time compliers, late or "reluctant" compliers, and noncompliers. Approximately 36% of subjects complied on time, 25% complied late, and 39% did not comply. RESULTS: Analyses showed that, relative to on-time and late compliers, noncompliers tended to be male, younger, of lower income and Spanish-literacy level, to drink more alcohol, to be less physically active, and to have lower dietary fat avoidance scores. No significant differences were found for other factors considered (e.g., physical health measures). CONCLUSIONS: These results generally reflect those of non-Hispanics that indicate that individuals at greater "risk" are less likely to comply with study protocols. Such results may be useful for designing culturally appropriate cohort maintenance strategies for longitudinal studies with Latinos.

Breast self-examination among college women: predictors for cancer control.

Monthly breast self-examination (BSE) to aid in the early diagnosis of breast cancer is advocated for all adult women, but regular and competent practice is unusual. Our purpose was to explore the associations between young women's reported cancer history, BSE training, demographic variables (predictors), self-reported frequency of BSE, BSE skill level, breast lump detection ability, confidence, and anxiety (outcome variables). A general health history questionnaire was administered to 73 female university students, faculty, and staff. BSE skill and detection ability were measured by observation; confidence and anxiety ratings were obtained by interview. BSE frequency was predicted by employment status and cyclically enlarged breasts, while BSE skill was related to professional BSE training and the length of that training plus bra size. Surprisingly, BSE training was not found to be associated with self-reported BSE frequency. These analyses suggest that BSE training may result in more complete BSE (although well below acceptable standards) performed by women who are moderately confident and sensitive to the risk of breast cancer--but not in more frequent BSE.

The use of volunteers in mass screening for high blood pressure.

This paper describes the effectiveness of an incentive-based approach to screening for hypertension by comparing it to two more typical on-site screenings. In the "bounty system," adolescents were trained and certified in blood pressure assessment to enable them to conduct door-to-door blood pressure screenings. The youths received incentives for various phases of their training and the screenings. The two other screenings were conducted in a worksite and a public "community" setting. It was evident that incentives played a major role in recruiting adolescents to volunteer as screeners. The final results, however, revealed that this contact did not result in an increase in the number of persons screened as had been predicted. This was due in part to the reluctance of residents to admit teenagers into their homes and related problems.

Longitudinal effects of preventive services on health behaviors among an elderly cohort.

This study examines the longitudinal (48 months) effects of a preventive services intervention trial with Medicare beneficiaries. The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise. All subjects completed a health risk appraisal (HRA) questionnaire, which served as a dependent measure. Results show significant, positive changes in intervention subjects in two activity outcomes, aerobic activity and stretching exercises. Although previous research on this cohort found significant positive changes in nutrition behaviors at 12-month follow-up, these differences were not sustained over the three-year follow-up period. The results offer encouragement that continued research on health promotion will eventually produce protocols for select activities that will improve the status of seniors' health.

Promoting the selection of healthy food through menu item description in a family-style restaurant.

We describe an attempt to influence the selection of menu items in a family-style restaurant. Three different messages, varying in content and emphasis, were used to promote one food special each intervention day. One message emphasized that the specials were particularly healthful, being relatively low in fat, sodium, and cholesterol. A second message stressed flavor and added that the choice was healthful. A third, nonspecific message made no mention of taste or health factors, but simply noted that there was a daily special. Results indicated that restaurant patrons selected healthful specials when the message noted that the choice was healthful but emphasized flavor. Patrons were apparently more open to information about the palatability of the food than its healthfulness per se. These results have implications for point-of-purchase health promotion efforts in general, especially those involving food-labeling programs in restaurants and grocery stores.