Relations of Neighborhood Environment Influences, Physical Activity, and Active Transportation to/from School across African American, Latino American, and White Girls in the United States.

BACKGROUND: Neighborhood environment influences may be particularly important for understanding physical activity (PA) patterns across ethnic subgroups of early adolescent girls. PURPOSE: This study examined relationships between neighborhood variables, moderate to vigorous physical activity (MVPA), and active transportation to/from school across African American, Latino American, and White early adolescent girls living in an urban/suburban community in the northwestern U.S.A. Relations between the neighborhood variables across ethnic groups also were examined. METHOD: The sample comprised 372 African American, Latino American, and White girls living in the U.S.A. (mean age = 12.06 years; SD = 1.69). RESULTS: Data were analyzed using multiple-sample structural equation modeling. Results showed that girls' MVPA was positively related to physical activity facility accessibility and negatively related to age. Active transport was positively related to physical activity facility accessibility, neighborhood walkability, and age, and negatively related to distance to the nearest school and household income. CONCLUSIONS: Findings highlight the importance of both perceived and objective neighborhood influences on girls' MVPA and active transport. Consistencies in findings across African American, Latino American, and White girls suggest that neighborhood-level PA promotion has the potential for broad impact across all three ethnic groups.

A measurement model of youth physical activity using pedometer and self, parent, and peer reports.

BACKGROUND: Because no single measure is able to accurately assess all types of physical activity (PA), some researchers advocate use of multiple methods and multiple informants to measure PA. However, little research has tested the validity of proxy reports of youth PA. PURPOSE: The current study determined whether peer, parent, and self-reports reflects a latent measure of youth PA. As a test of construct validity, pedometer data were included in the model and covaried with the second-order target youth PA factor to determine the relationship between the youth PA factor and an objective measure of PA. METHOD: Participants included 291 target youth (ages 10, 12, or 14 years), a peer, and a parent of each target child (N = 873). Each participant reported about target children's vigorous PA during the past 7 days, days of PA in a typical week, and PA compared to others the same age and sex. Pedometers recorded the average number of steps taken per day by target youth over 7 days. RESULTS: Analyses indicated an acceptable fit of the model to the data, as all variables loaded significantly on their respective factors, and all factors had significant loadings on the higher-order target PA factor. A moderate correlation was observed between the higher-order youth PA factor and the pedometer measure. CONCLUSION: Combining multiple reports of youth PA has the potential to yield a more comprehensive measure of youth PA but may not be practical for all studies.

Use of a Local Worker Survey as a Source of Neighborhood Information.

Researchers increasingly recognize the potential influence of the neighborhood environment on individual health and social behavior. To examine these influences, it is important to use varying measures and sources of neighborhood characteristics. Though neighborhood residents are often surveyed, the perceptions of neighborhood workers have been largely ignored. The current study documents procedures and findings from two longitudinal studies in which workers in 60 neighborhoods were surveyed about neighborhood social cohesion and social control (collective efficacy), and neighborhood problems. Results indicated that workers within neighborhoods were more homogeneous in their views of neighborhood collective efficacy and neighborhood problems than were workers across neighborhoods. In addition, workers' perceptions of their neighborhoods were similar to the perceptions of neighborhood residents, but also provided unique information. Overall, this study demonstrates the viability and usefulness of local workers as an additional source of neighborhood information.

Reliability of pedometer data in samples of youth and older women.

BACKGROUND: Pedometers offer researchers a convenient and inexpensive tool for objective measurement of physical activity. However, many unanswered questions remain about expected values for steps/day for different populations, sources of variation in the data, and reliability of pedometer measurements. METHODS: This study documented and compared mean steps/day, demographic predictors of steps/day, and pedometer reliability in two longitudinal investigations, one involving a population-based youth sample (N = 367) and the other targeting postmenopausal women with type 2 diabetes (N = 270). Individuals were asked to wear pedometers (Yamax model SW-701) at the waist for 7 days and record steps/per day. They were also asked to record daily physical activities, duration, and perceived intensity (1 = low/light, 2 = medium/moderate, 3 = high/hard) for the same 7 days. In addition, survey data regarding usual physical activity was collected. Analyses of variance (ANOVA) were conducted to determine whether there were significant differences in pedometer results according to sex, age, and body mass index. Repeated measures ANOVAs were used to examine potential differences in results among differing numbers of days. RESULTS: Mean steps/day were 10,365 steps in the youth sample and 4,352 steps in the sample of older women. Girls took significantly fewer steps than boys, older women took fewer steps than younger women, and both youth and women with greater body mass took fewer steps than those with lower body mass. Reliability coefficients of .80 or greater were obtained with 5 or more days of data collection in the youth sample and 2 or more days in the sample of older women. Youth and older women were more active on weekdays than on weekends. Low but significant associations were found between step counts and self-report measures of physical activity in both samples. CONCLUSION: Mean steps/day and reliability estimates in the two samples were generally consistent with previously published studies of pedometer use. Based on these two studies, unsealed pedometers were found to offer an easy-to-use and cost-effective objective measure of physical activity in both youth and older adult populations.

Tai Chi and fall reductions in older adults: a randomized controlled trial.

BACKGROUND: The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. METHODS: This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. RESULTS: At the end of the 6-month intervention, significantly fewer falls (n=38 vs 73; p=.007), lower proportions of fallers (28% vs 46%; p=.01), and fewer injurious falls (7% vs 18%; p=.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p<.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. CONCLUSIONS: A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.

Sports Participation and Positive Correlates in African American, Latino, and White Girls.

PURPOSE: The purpose of the study was to examine relations among sports participation and positive correlates across African American, Latino, and white girls. Positive correlate variables were self-perceptions (self-worth, body attractiveness, athletic competence), less depression, and participation in extracurricular activities. METHODS: The sample comprised 372 girls (mean age = 12.03 years). Data were analyzed using multiple-sample structural equation models, controlling for age and income. RESULTS: Across all ethnic groups, greater sports participation was significantly related to higher self-worth, body attractiveness, and athletic competence, and to more extracurricular activity. Among Latino and white girls only, greater sports participation also was related to less depression. There were significant age and income influences on the positive correlates. CONCLUSIONS: Findings confirm the existence of significant relationships between organized sports participation and positive correlates among early adolescent African American, Latino, and white girls. Despite a few ethnic differences in relationships, the current study revealed more similarities than differences.

School influences on the physical activity of African American, Latino, and White girls.

BACKGROUND: The purpose of this research was to examine the impact of school-related variables on the physical activity (PA) levels of early adolescent African American, Latino, and White girls. METHODS: Data were collected from 353 African American (N = 123), Latino (N = 118), and White (N = 112) girls. Physical activity levels included a PA latent factor and minutes per day of moderate-to-vigorous physical activity (MVPA). School variables included hours of physical education (PE), PE enjoyment, school physical environment, recess activity, and active transport to/from school. Multiple-group structural equation modeling examined relations between school variables and PA across ethnic groups. RESULTS: Hours of PE were positively related to higher PA factor scores. Active transport was related to higher PA factor scores for White girls only, and to greater MVPA for African American girls only. Hours of PE were related to PE enjoyment and the school physical environment for some ethnic groups. Physical education enjoyment was related to more recess activity among African American and Latino girls, and PE enjoyment was associated with more active transport to school for all girls. CONCLUSIONS: Physical education participation and active transport significantly contribute to girls' levels of PA, with differences across ethnic groups.

Personal, Family, and Peer Correlates of General and Sport Physical Activity among African American, Latino, and White Girls.

This study examined associations between personal, family, and peer variables on objectively measured physical activity (PA), and sports participation, of African American, Latino, and white girls. Specific variables included barriers efficacy, parent PA, parent support of PA, the home exercise environment, friends' PA, and friends' support of PA. The sample comprised 372 girls (mean age = 12.03 years; SD = 1.81; n = 128 African American, n = 120 Latino, and n = 124 white). Data were analyzed using multiple-sample structural equation models (by ethnicity), controlling for age, household income, body mass index, and physical development. Girls' moderate to vigorous PA (MVPA) was positively related to friends' support for all groups, and to parent PA only for African American girls. For sports, greater parental support related to more participation across ethnic/racial groups, whereas friends' support was important only for African American girls. Age and physical development were negatively related to MVPA, and higher income was associated with greater sports participation. Numerous significant correlations emerged between the independent variables, with some differences across racial/ethnic groups. Findings highlight the role of parent and friends' support for both MVPA and sports participation of early adolescent girls, as well as the importance of determining PA correlates among different ethnic/racial subgroups.

Surgeons' tone of voice: a clue to malpractice history.

BACKGROUND: Interpersonal aspects of care, such as the communication behaviors of physicians, are often cited as central to patients' decisions to initiate malpractice litigation. Relatively little is known, however, about the impact of the communication behaviors of surgeons. In the current study, we investigated the relationship between judgments of surgeons' voice tone and their malpractice claims history. METHODS: We examined the relationship between surgeons' voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons' claims status. Two 10-second clips were extracted for each surgeon from the first and last minute of their interactions with 2 different patients. Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone. RESULTS: Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.16 to 6.43 for dominance; OR 0.46, 95% CI 0.21 to 1.01 for concern/anxiety). CONCLUSIONS: Surgeons' tone of voice in routine visits is associated with malpractice claims history. This is the first study to show clear associations between communication and malpractice in surgeons. Specific types of affect associated with claims can be judged from brief audio clips, suggesting that this method might be useful in training surgeons.

Self-efficacy as a mediator between fear of falling and functional ability in the elderly.

OBJECTIVES: This study examined falls self-efficacy and fear of falling to determine whether self-efficacy acts as a mediator between fear of falling and functional ability. METHODS: Using the Survey of Activities and Fear of Falling in the Elderly as a fear-of-falling measure and the Activities-Specific Balance Confidence Scale for falls self-efficacy, structural relationships among fear of falling, self-efficacy, functional balance, and physical functioning outcomes were tested with older adults (N = 256, M age = 77.5). RESULTS: Lower levels of fear of falling were significantly related to higher levels of falls self-efficacy, which was in turn associated with better functional outcomes. Moreover, falls self-efficacy mediated the effects of fear of falling on functional outcomes. DISCUSSION: Results substantiate the hypothesized mediational role of falls self-efficacy in fear of falling and underscore the need to consider ways of enhancing falls self-efficacy in interventions aimed at reducing falls and fear of falling.

Telephone Recruitment of a Random Stratified Youth Sample for a Physical Activity Study.

It is important that studies on youth health behavior obtain sufficiently large representative samples so that power is adequate and results are generalizable. Few researchers, however, have documented procedures and methods for recruitment of a random stratified youth sample for studies on health-related behavior, specifically physical activity. This study describes the recruitment methods used to attain a stratified sample of 360 target youth (male and female from 10-, 12-, and 14-year old cohorts), and a parent of each child, representing families in 58 different neighborhoods. A peer of each target youth was also invited to participate. Recruitment was conducted primarily by telephone, using computer-assisted telephone interviewing (CATI) software. Approximately 38% of calls resulted in person contact, of which about 98% of families did not qualify. Of those qualified, about 68% agreed to participate. The telephone recruitment was supplemented by door-to-door recruitment in selected neighborhoods. The average cost of telephone recruitment was approximately $99 per family. Advantages and limitations of the recruitment method are discussed.

Health risks of Oregon eighth-grade participants in the "choking game": results from a population-based survey.

OBJECTIVE: To examine the risk behaviors associated with participation in the "choking game" by eighth-graders in Oregon. METHODS: We obtained data from the 2009 Oregon Healthy Teens survey, a cross-sectional weighted survey of 5348 eighth-graders that questioned lifetime prevalence and frequency of choking game participation. The survey also included questions about physical and mental health, gambling, sexual activity, nutrition, physical activity/body image, exposure to violence, and substance use. RESULTS: Lifetime prevalence of choking game participation was 6.1% for Oregon eighth-graders, with no differences between males and females. Of the eighth-grade choking game participants, 64% had engaged in the activity more than once and 26.6% >5 times. Among males, black youth were more likely to participate than white youth. Among both females and males, Pacific Islander youth were much more likely to participate than white youth. Multivariate logistic regression revealed that sexual activity and substance use were significantly associated with choking game participation for both males and females. CONCLUSIONS: At >6%, the prevalence of choking game participation among Oregon youth is consistent with previous findings. However, we found that most of those who participate will put themselves at risk more than once. Participants also have other associated health risk behaviors. The comprehensive adolescent well visit, as recommended by the American Academy of Pediatrics, is a good opportunity for providers to conduct a health behavior risk assessment and, if appropriate, discuss the dangers of engaging in this activity.

Correlates of gambling among eighth-grade boys and girls.

BACKGROUND: This study examined the correlates of gambling behavior among eighth-grade students. METHODS: Children (n = 15,865) enrolled in publicly funded schools in Oregon completed the 2008 Oregon Healthy Teens survey. Multivariate logistic regression analyses assessed the combined and independent associations between risk and protective factors with active gambling among male and female youth separately. RESULTS: Approximately 17% of eighth-grade girls and 33% of eighth-grade boys had gambled during the past 3 months. Most health risk behaviors were positively associated with gambling. However, gambling was also positively associated with frequent physical activity participation and, among boys, eating 5 daily servings of fruits and vegetables. Logistic regression analyses identified significant differences among risk and protective factors between active gamblers and non-gamblers. Regardless of gender, relative to active gamblers, non-gamblers were more likely to hold strong personal health beliefs, be uninvolved in antisocial behavior, exhibit good safety behaviors, and not have experienced a mouth injury while playing sports during the past year. Female gamblers were more likely to be active tobacco users, to speak a language other than English at home, and engage in more than 2 hours a day of screen time than non-gamblers. Male gamblers were more likely to be physically active, Hispanic, use alcohol, and perceive lower levels of social control in their neighborhoods than non-gamblers. CONCLUSIONS: Gambling may be a topic that is appropriate for inclusion in school programs targeting health risk reduction among eighth-grade students.

A cohort-sequential latent growth model of physical activity from ages 12 to 17 years.

BACKGROUND: Despite serious public health implications of decreased physical activity during adolescence, few longitudinal studies have been conducted to determine the trajectory and important correlates of physical activity change during this period. PURPOSE: This study examines change in physical activity from ages 12 to 17 years and the influences of personal, family, peer, and demographic factors on activity patterns. METHODS: Data were from 371 youth. The sample was 50.1% female, 76% White, 12% African American, 4% Hispanic, 2% Asian, 2% American Indian, and 4% other or mixed races. Mean age was 12.05 years (SD = 1.63) at Time 1. Multivariate latent growth curve modeling (LGM), a cohort-sequential design, and a multiple-group design by sex were employed. RESULTS: Youth physical activity declined significantly from ages 12 to 17. Boys had higher initial levels of physical activity than girls. Efficacy to overcome barriers, physically active friends, and friend social support all played roles in reducing the decline in physical activity. Early maturing boys, although more physically active initially, experienced a greater decline in physical activity compared to later maturing boys. CONCLUSIONS: These findings encourage further research on the etiology and development of youth physical activity using procedures such as LGM to better understand the risk and protective factors associated with youth physical activity decline.

A multilevel approach to youth physical activity research.

Social environment factors are hypothesized to interact with individual-level factors to influence youth physical activity. Multilevel analytic approaches are ideal for examining the influence of the social environment on youth physical activity as they allow examination of research questions across multiple contexts and levels ( e.g., individual, family, and neighborhood levels).

Relations between youth antisocial and prosocial activities.

This study examines relations among antisocial and prosocial activities for boys and girls aged 10, 12, and 14 years. Antisocial activities included substance use and other deviant behaviors. Prosocial activities included physical activity, organized sports, organized nonsport activities, volunteer and religious activities. Household income and single-parent vs. two-parent family status were included as covariates. The sample comprised 356 youth (mean age = 12.06 years, 50% female, 73% White). A six-group (Age x Gender) multiple-sample structural equation model was employed to determine the existence of latent factors (substance use, deviant behaviors, prosocial activities) and relations among variables. Results showed a positive relationship among prosocial behaviors, and between substance use and other deviant behaviors. Organized sport and days of physical activity were inversely related to substance use. Higher income and living in a two-parent family were associated with less substance use and deviant behavior. There was little variation by gender and age.