Interprofessional social and emotional intelligence skills training: study findings and key lessons.

Frequently changing demands in health care systems have focused attention on the need for emotional competence (EC) - social and emotional intelligence skills, to adapt efficiently, responsively and productively. This paper reports on findings from a workshop that introduced practical EC skills to nearly 1000 participants in education, medicine, mental health and substance abuse counseling. The holistic EC presentations were designed to teach concepts and principles providing each participant with the opportunity for individualized learning. Ninety percent of the participants rated these presentations as valuable and useful. Following this positive response, the approach was adapted to train health professionals serving diverse populations. This report shares our experience teaching various professionals and describes preliminarily testing of the adapted EC training program on a small group of health professionals, whose responsibilities included teamwork, program design, teaching clients and patients EC basics to support healthy practices and self-care. Their positive response supports the need for expanded study and further investigation.

Booster Breaks in the workplace: participants' perspectives on health-promoting work breaks.

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces.

Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study.

BACKGROUND: Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day. Within this time frame, children accumulate most of their activity within the first 10 min. This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study. The STEP study is a cluster randomized controlled study designed to examine the effects of short bouts of structured physical activity (SBS-PA) implemented within the classroom setting as part of designated gross-motor playtime on during-school physical activity (PA) in preschoolers. METHODS/DESIGN: Ten preschool centers serving low-income families were randomized into SBS-PA versus unstructured PA (UPA). SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting, twice daily, followed by 20 min of usual unstructured playtime. UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily. Interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for six months. Outcome measures were between group difference in during-preschool PA (accelerometers and direct observation) over six-months. Ten preschool centers, representing 34 classrooms and 315 children, enrolled in the study. The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile, respectively. Participants spent 74% and 6% of their preschool day engaged in sedentary and MVPA, respectively. DISCUSSION: Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers' PA levels.

A midpoint process evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009.

BACKGROUND: Racial/ethnic minority groups have higher risks for disease resulting from obesity. COMMUNITY CONTEXT: The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites. METHODS: We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach. OUTCOME: Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies. INTERPRETATION: Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.

Impact of a worksite wellness program on the nutrition and physical activity environment of child care centers.

PURPOSE: To test whether implementing a staff wellness program affects the nutrition and physical activity environment at child care centers. DESIGN: Quasi-experimental controlled trial. SETTING: Child care centers in low income neighborhoods in California. SUBJECTS: Eighty-two staff members at 13 centers completed the study. INTERVENTION: Intervention and control groups received training and education about nutrition and physical activity. The intervention group also participated in a worksite wellness program. MEASURES: Staff members' personal health habits, self-efficacy in working with families on nutrition and physical activity, and changes in children's food and physical activity environments were assessed. ANALYSIS: Statistical software was used to analyze change scores for pre-post measures and to test differences for end point-only measures. RESULTS: Although significant differences in staff members' personal health behaviors were not observed, staff from intervention sites exhibited more positive changes in their comfort level in talking to parents about nutrition and physical activity. Intervention sites reported providing more fresh fruits (p = .004) and vegetables (p = .03) to children as part of regular meals and snacks and serving more fresh fruits (p = .05) at children's celebrations. Control sites reported greater increases in sweetened foods (p = .02) and sweetened beverages (p = .05) at children's celebrations. CONCLUSION: The wellness intervention shows promise in improving the children's food environment in a child care setting.

Health promotion in barbershops: balancing outreach and research in African American communities.

Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities. In particular, barbershop-based health promotion as conducted by the Black Barbershop Health Outreach Program has successfully reached nearly 10,000 men nationwide through a grassroots, volunteer-driven effort. At the same time, researchers have begun to conduct formal clinical trials in barbershops in order to explore interventions targeting this at-risk population. Herein, we describe, in brief a review of barbershop-based health promotion and the experience of this novel community-based organization. We argue for continuing to integrate evaluation and research using community-partnered principles into successful grassroots initiatives without dulling the practical impact of these programs is a crucial next step as we move beyond simply acknowledging health disparities and seek to find solutions.

Cardiovascular disease control through barbershops: design of a nationwide outreach program.

OBJECTIVES: To review the success of barbershops as vehicles for health promotion and outline the Black Barbershop Health Outreach Program (BBHOP), a rapidly growing, replicable model for health promotion through barbershops. METHODS: BBHOP was established by clinicians in order to enhance community level awareness of and empowerment for cardiometabolic disorders such as diabetes and cardiovascular disease. At coordinated events utilizing existing infrastructures as well as culturally and gender-specific health promotion, BBHOP volunteers screen for diabetes and hypertension and reinforce lifestyle recommendations for the prevention of cardiometabolic disorders from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Patrons with abnormal findings are referred to participating physicians or health care facilities. We performed a selective review of the literature in order to place this model for health promotion in the context of previous efforts in barbershops. BBHOP is among several successful programs that have sought to promote health in barbershops. Combining a grassroots organization approach to establishing a broad-based network of volunteers and partner agencies with substantial marketing expertise and media literacy, the BBHOP has screened more than 7000 African American men in nearly 300 barbershops from more than 20 cities across 6 states. CONCLUSIONS: The BBHOP is an effective method for community level health promotion and referral for cardio-metabolic diseases, especially for AA men, one of the nation's most vulnerable populations.

A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising.

CONTEXT: Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient-dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities. METHODS: Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia. FINDINGS: Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities. CONCLUSIONS: The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government's ability to regulate advertising, the success of limiting tobacco advertising offers lessons for reducing the marketing contribution to the obesigenicity of urban environments.

The meta-volition model: organizational leadership is the key ingredient in getting society moving, literally!

This paper argues that substantive and sustainable population-wide improvements in physical activity can be achieved only through the large scale adoption and implementation of policies and practices that make being active the default choice and remaining inactive difficult. Meta-volition refers to the volition and collective agency of early adopter leaders who implement such changes in their own organizations to drive productivity and health improvements. Leaders, themselves, are motivated by strong incentives to accomplish their organizational missions. The meta-volition model (MVM) specifies a cascade of changes that may be sparked by structural integration of brief activity bouts into organizational routine across sectors and types of organizations. MVM builds upon inter-disciplinary social ecological change models and frameworks such as diffusion of innovations, social learning and social marketing. MVM is dynamic rather than static, integrating biological influences with psychological factors, and socio-cultural influences with organizational processes. The model proposes six levels of dissemination triggered by organizational marketing to early adopter leaders carried out by "sparkplugs," boisterous leaders in population physical activity promotion: initiating (leader-leader), catalyzing (organizational-individual), viral marketing (individual-organizational), accelerating (organizational-organizational), anchoring (organizational-community) and institutionalizing (community-individual). MVM embodies public-private partnership principles, a collective investment in the high cost of achieving and maintaining active lifestyles.

Promoting physical activity and healthy eating: convergence in framing the role of industry.

This commentary addresses a little explored aspect of prevention, namely, how public health practitioners conceptualize the roles of industries whose business interests may be at odds with physical activity and eating nutrient-rich foods. Taking their cues from successful campaigns in tobacco control, many public health advocates have framed obesity as a battle with the food industry. Such framing presents problems when it exacerbates existing tensions between practitioners in nutrition and physical activity, and alienates potential fitness industry partners. Creating healthy environments requires reframing expectations of all industries that influence physical activity and inactivity. A broader view of the influence of corporate practices on physical and social environments will help both physical activity and nutrition advocates identify what they can do together, and in partnership with the business sector, to create environments that promote activity and nutritious eating.

Physical activity: Cinderella or Rodney Dangerfield?

Physical inactivity is one of the leading causes of death, disability, and health care costs, but resources and other investments in promoting physical activity are neither proportional to nor ideally suited to address the problem, especially in the United States. Capacity for physical activity promotion is lacking, when compared to the response to other major health risk and protective behaviors. The authors of the commentaries in this special issue were asked to identify key issues from a variety of perspectives and to recommend actions that can be taken now to increase physical activity across the population so that all segments of society benefit, especially those at high risk of chronic diseases. The goal is to stimulate research institutions, public health agencies at all levels, and policy makers to raise physical activity as a priority commensurate with other pressing public health concerns.

Resilience and patterns of health risk behaviors in California adolescents.

OBJECTIVES: Assess whether adolescent health risk behaviors cluster, and whether resiliency factors are associated with observed clusters. METHODS: The cross-sectional population-weighted 2003 California Health Interview Survey was used (N=4010). Four gender-specific clusters were based on smoking, alcohol use, low fruit/vegetables consumption, and physical inactivity. Resiliency factors included parental supervision, parental support, role model presence and adolescent mental health. Conditional regression was used to measure the association of individual health risk behaviors and clusters with resiliency factors. RESULTS: Health risk behaviors clustered as follows: "Salutary Adherents" (no reported health risk behaviors), "Active Snackers" (physically active, low fruit/vegetable consumers), "Sedentary Snackers" (physically inactive, low fruit/vegetable consumers), and "Risk Takers" (smokers, alcohol users, many also physically inactive and low fruit/vegetable consumers). Greater parental supervision was associated with lower odds of being in unhealthful clusters. Among males, having greater parental support reduced odds of being an "Active Snacker" or "Sedentary Snacker." Among females, role model presence reduced odds of being in unhealthful clusters, while depressiveness increased the odds. CONCLUSIONS: Health promoting interventions should address multiple health risk behaviors in an integrated fashion. Gender-specific, ethnically-targeted, family-centered strategies that address parenting, particularly parental supervision would be useful. Addressing depressiveness may be especially important for female adolescents.

Disparities in physical activity and sedentary behaviors among US children and adolescents: prevalence, correlates, and intervention implications.

Regular physical activity is important for health benefits among youth, but disparities exist. This paper describes disparities in physical activity participation and sedentary behaviors among youth in the United States, provides intervention implications, and offers recommendations for future research focused on reducing disparities related to levels of physical activity. Secondary analysis of national accelerometer data showed that achievement of recommended levels of physical activity ranged across subgroups from 2% to 61%. Mean hours per day spent in sedentary behavior ranged from 5.5 to 8.5. The largest disparities were by gender and age. An improved understanding of correlates may inform the design of interventions to increase physical activity in targeted subgroups. Additional theoretically based research is needed to elucidate which factors contributing to physical activity disparities are amenable to change via intervention. To eliminate health disparities, changes in policies that have an impact on physical activity may be necessary to promote physical activity among high-risk youth.

Clustering of unhealthy outdoor advertisements around child-serving institutions: a comparison of three cities.

Using GPS devices and digital cameras, we surveyed outdoor advertisements in Austin, Los Angeles and Philadelphia. GIS and hot spot analysis revealed that unhealthy ads were clustered around child-serving institutions in Los Angeles and Philadelphia but not in Austin. Multivariate generalized least square (GLS) regression models showed that percent black (p<0.04) was a significant positive predictor of clustering in Philadelphia and percent white (p<0.06) was a marginally significant negative predictor of clustering in Los Angeles after controlling for several land use variables. The results emphasize the importance of zoning and land use regulations to protect children from exposure to unhealthy commercial messages, particularly in neighborhoods with significant racial/ethnic minority populations.

Adapting a 1% or less milk campaign for a Hispanic/Latino population: the Adelante Con Leche Semi-descremada 1% experience.

PURPOSE: Describe and evaluate a media campaign to encourage 1% or nonfat milk consumption. DESIGN: Uncontrolled pre/post test. SETTING: One largely rural (Santa Paula) and one urban (East Los Angeles) California community. SUBJECTS: Community residents and milk vendors in primarily low-income Latino/Hispanic communities. INTERVENTION: The "1% or Less" milk campaign, which promotes substitution of 2% fat or whole milk with 1% or less fat milk was adapted and implemented. MEASURES: Comparison of post-campaign milk sales with pre-campaign sales. ANALYSIS: Chi-square tests of independence used to compare precampaign and postcampaign sales. RESULTS: There were decreases in the proportion of whole milk sold and increases in the proportion of reduced-fat, low-fat, and nonfat milk sold in the weeks following each campaign (Santa Paula: p = .0165; East Los Angeles: p < .0001). However, follow-up data from East Los Angeles suggest that these changes were not sustained. The proportions of the different units of milk sold also changed in the weeks following each campaign (p < .0001). Sales of whole milk gallon units decreased from 36.3% to 28.4% in Santa Paula, and from 43.5% to 10.2% in East Los Angeles. CONCLUSION: Highly focused campaigns to promote substitution of high-fat milk with low-fat or nonfat milk can show dramatic initial changes in sales patterns. However, whether such campaigns can have a sustained impact in largely Latino/Hispanic communities is not evident.

Process evaluation of the Los Angeles Unified School District Nutrition Network.

INTRODUCTION: This study evaluated the Los Angeles Unified School District Nutrition Network, a large multicomponent nutrition and physical activity program in an ethnically diverse school district, launched in 2000. METHODS: We calculated descriptive statistics and performed hierarchical logistic regression on school-level demographic and implementation data. RESULTS: Thirty-six percent of eligible schools participated in 2001, and 79% of participating schools reapplied the following year. Elementary schools and schools that applied for grant money were more likely to re-apply. Produce sampling was the most frequently cited program highlight, and making purchases with program grant money was the most frequently cited challenge. CONCLUSION: Our findings suggest that schools serving students of low socioeconomic status and diverse ethnicities can be recruited into a large program to promote healthy dietary choices and physical activity, especially elementary schools. Effectiveness and institutionalization of the program might be positively affected by fostering local ownership, allowing school personnel who apply for the grant to tailor the program to their individual schools.

Correlation of obesity with elevated blood pressure among racial/ethnic minority children in two Los Angeles middle schools.

INTRODUCTION: To identify anthropometric and fitness correlates of elevated blood pressure, serum cholesterol, and glycated hemoglobin, we examined anthropometric and physiologic biomarkers among racial/ethnic minority children aged 11 to 13 years in two urban Los Angeles middle schools. We explored the potential for using obesity or fitness level as screening variables for cardiovascular disease risk factors in these students. METHODS: During regularly scheduled physical education classes, we collected data on demographic characteristics, height, weight, blood pressure, nonfasting total serum cholesterol, glycated hemoglobin, time to run/walk 1 mile, and a range of self-reported behaviors. A total of 199 sixth-graders (121 Latinos, 78 African Americans) participated in the study. RESULTS: Bivariate analyses indicated that 48.6% of sixth-graders were of desirable weight, 17.5% were overweight, 29.9% were at risk for overweight, and 4.0% were underweight. Higher weight was associated with higher levels of serum cholesterol, systolic blood pressure, and diastolic blood pressure (P values for all associations <.02) but not with glycated hemoglobin. Multivariate analyses maintained the findings with regard to blood pressure but not serum cholesterol. CONCLUSION: Overweight status could be a screening variable for identifying youth at risk for high blood pressure. Obesity prevention and intervention programs and policies need to target low-income racial/ethnic minority children. Assessment of hypertension status also seems warranted in low-income racial/ethnic minority sixth-graders, as does early intervention for children at high risk.

Pausa para tu Salud: reduction of weight and waistlines by integrating exercise breaks into workplace organizational routine.

INTRODUCTION: Proactive worksite strategies that change the physical or sociocultural environment(s) to incorporate obligatory physical activity may be necessary to engage sedentary people. This study describes implementation and evaluation of an intervention, Pausa para tu Salud (Pause for Your Health), that integrated a brief period of group exercise into the workday. METHODS: An uncontrolled pretest-post-test study design tested the effects of integrating daily 10-minute exercise breaks during paid work time during January 2003 through January 2004. A total of 335 Mexican Ministry of Health office workers provided baseline data as a part of routine annual clinical screening examinations. RESULTS: Baseline mean body mass index and waist circumferences were 27.8 kg/m(2) and 87.6 cm for women and 26.6 kg/m(2) and 89.7 cm for men. Complete data were available for 271 (80.9%) employees at 1-year follow-up. Two-tailed, paired t-test comparisons were used. Body mass index decreased by 0.32 kg/m(2) (P = .05), and waist circumference by 1.6 cm (P = .0009) overall. The body mass index decrease, however, was significant only for men (-0.43 kg/m(2), P = .03). Multivariate analyses revealed a significant decrease in diastolic blood pressure among women (z = -2.04, P = .042). CONCLUSION: The intervention was associated with significant improvements in both measures of body composition. Substantive health and organizational benefits may result from integrating brief periods of physical activity into the workday if these findings are replicated in randomized controlled trials in other worksites.

Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research.

In this review, our first purpose is to provide an overview of existing physical activity intervention research, focusing on subpopulations and intervention modalities. Our reviews within each area are not exhaustive or quantitative, as each area has been reviewed in more depth in numerous other reports. Instead, our goal is to provide a single document that provides a qualitative overview of intervention research that emphasizes selected topics of particular importance for improving the population-wide impact of interventions. Therefore, in synthesizing this vast literature, we begin with existing reviews of physical activity research in each area and incorporate in our discussions recent reports of well-designed individual physical activity intervention studies that expand the existing research base and/or target new areas of research. Our second purpose is to offer new ideas and recommendations to improve the state of the science within each area and, where possible, to propose ideas to help bridge the gaps between these existing categories of research.