Physical activity in young adults: a signal detection analysis of Health Information National Trends Survey (HINTS) 2007 data.

Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.

Delivering health information via podcast or web: media effects on psychosocial and physiological responses.

This study explored differences in psychosocial and physiological variables in response to being presented with information on weight loss through either reading text on a website or listening to the same information via podcast. Participants were randomized to receive a weight loss website (n = 20) or podcast (n = 20). Participants had skin conductance levels measured and completed questionnaire items assessing demographic characteristics, user control, novelty, and knowledge. Participants in the podcast group exhibited greater levels of physiological arousal and reported the intervention to be more novel than those in the Web group; however, the Web group reported greater user control. There was no difference in knowledge between the groups. This study presents the first step in examining the role that novelty and user control may play in two different weight-loss electronic media, as well as differences in knowledge acquisition. Future research should explore adding additional media features, such as video content, to the podcasts and websites in order to optimize fully the different mediums and to examine whether user control and novelty are potential mediators of weight loss outcomes.

Cancer screening patterns by weight group and gender for urban African American church members.

Obese white women have lower rates of cancer screening compared to non-obese women. This study will determine if a relationship exists between weight and adherence to cancer screening guidelines among African Americans. We used multivariate logistic regression to examine the relationship between being up-to-date with cancer screening (colorectal, breast, cervical, and prostate) and weight group (normal, overweight, obese I, obese II+) using data from older (age 50+) members (N = 955) of 20 African American churches in Michigan and North Carolina. CRC testing rates were examined using multiple definitions to account for differences in screening rates vs. polyp surveillance rates. After adjusting for confounders, we found relationships between weight group and up-to-date CRC (P = 0.04) and PSA (P = 0.004) testing for men and mammography (P = 0.03) for women. Compared to normal-weight men, obese I men were more likely to be up-to-date with CRC (OR 2.35, 95%CI 1.02-5.40) and PSA (OR 4.24 95%CI 1.77-10.17) testing. CRC screening rates were lower when individuals with polyps were excluded from the analysis; however, patterns by weight remained the same. Contrary to previous research, we did not find lower rates of cancer screening among obese African Americans. Instead, we found that normal-weight African American men had lower screening rates than any other group. As we did not consistently find lower screening rates among obese African Americans, targeting this group for increased screening promotion may not be the most effective way to reduce weight-related cancer disparities.

Colorectal cancer screening and physical activity promotion among obese women: an online evaluation of targeted messages.

Obese women are at higher risk for several cancers, but are less likely than normal weight women to engage in cancer prevention behaviors such as screening and physical activity. Targeted health messages may help increase healthy behaviors among vulnerable groups such as obese women. Using findings from focus groups with obese women, the authors created targeted messages to promote colorectal cancer screening and physical activity among obese women. The messages addressed psychosocial constructs, such as benefits and barriers to colorectal cancer screening and exercise, which were relevant to the target population. Messages were tested online with women age 50 years and older (N = 181). Participants were stratified by weight (obese vs. nonobese) and randomized to review either 10 targeted (intervention) or 10 generic (control) messages. Study outcomes included elaboration about the messages, message relevance and trustworthiness, and behavioral intentions. The authors used moderation and subgroup analyses to determine whether the intervention messages were better received by certain women. They found no differences in elaboration, behavioral intentions, relevance, or trustworthiness between intervention and control for either weight group. However, exercise intentions increased more (p = .06) among inactive obese women who received intervention messages (+2.9) compared with those who were in the control group (+1.2). Intervention messages also produced more elaboration among women who viewed their weight as a barrier to screening or exercise. Tailoring intervention messages for obese women on the basis of behavior and barriers may improve outcomes more than giving the same messages to all obese women.

Implementing the MOVE! weight-management program in the Veterans Health Administration, 2007-2010: a qualitative study.

INTRODUCTION: One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities. METHODS: Using a multiple, holistic case study design, we conducted 68 interviews with medical center program coordinators, physicians formally appointed as program champions, managers directly responsible for overseeing the program, clinicians from the program's multidisciplinary team, and primary care physicians identified by program coordinators as local opinion leaders. Qualitative data analysis involved coding, memorandum writing, and construction of data displays. RESULTS: Organizational readiness for change and having an innovation champion were most consistently the 2 factors associated with MOVE! implementation. Other organizational factors, such as management support and resource availability, were barriers to implementation or exerted mixed effects on implementation. Barriers did not prevent facilities from implementing MOVE! However, they were obstacles that had to be overcome, worked around, or accepted as limits on the program's scope or scale. CONCLUSION: Policy-directed implementation of clinical weight-management programs in health care facilities is challenging, especially when no new resources are available. Instituting powerful, mutually reinforcing organizational policies and practices may be necessary for consistent, high-quality implementation.

A behavioral intervention to improve obstetrical care.

BACKGROUND: Implementation of evidence-based obstetrical practices remains a significant challenge. Effective strategies to disseminate and implement such practices are needed. METHODS: We randomly assigned 19 hospitals in Argentina and Uruguay to receive a multifaceted behavioral intervention (including selection of opinion leaders, interactive workshops, training of manual skills, one-on-one academic detailing visits with hospital birth attendants, reminders, and feedback) to develop and implement guidelines for the use of episiotomy and management of the third stage of labor or to receive no intervention. The primary outcomes were the rates of prophylactic use of oxytocin during the third stage of labor and of episiotomy. The main secondary outcomes were postpartum hemorrhage and birth attendants' readiness to change their behavior with regard to episiotomies and management of the third stage of labor. The outcomes were measured at baseline, at the end of the 18-month intervention, and 12 months after the end of the intervention. RESULTS: The rate of use of prophylactic oxytocin increased from 2.1% at baseline to 83.6% after the end of the intervention at hospitals that received the intervention and from 2.6% to 12.3% at control hospitals (P=0.01 for the difference in changes). The rate of use of episiotomy decreased from 41.1% to 29.9% at hospitals receiving the intervention but remained stable at control hospitals, with preintervention and postintervention values of 43.5% and 44.5%, respectively (P<0.001 for the difference in changes). The intervention was also associated with reductions in the rate of postpartum hemorrhage of 500 ml or more (relative rate reduction, 45%; 95% confidence interval [CI], 9 to 71) and of 1000 ml or more (relative rate reduction, 70%; 95% CI, 16 to 78). Birth attendants' readiness to change also increased in the hospitals receiving the intervention. The effects on the use of episiotomy and prophylactic oxytocin were sustained 12 months after the end of the intervention. CONCLUSIONS: A multifaceted behavioral intervention increased the prophylactic use of oxytocin during the third stage of labor and reduced the use of episiotomy. (ClinicalTrials.gov number, NCT00070720 [ClinicalTrials.gov]; Current Controlled Trials number, ISRCTN82417627 [controlled-trials.com].).

Information processes mediate the effect of a health communication intervention on fruit and vegetable consumption.

Health communication interventions have been effective in promoting fruit and vegetable consumption (FVC). To explore mechanisms underlying health communication effectiveness, the authors investigated whether information processes mediated the relationship between health communication and FVC, using data from NC STRIDES. NC STRIDES tested the efficacy of two health communication strategies to promote FVC among a diverse population-based sample of older adults. Participants were randomized to 1 of 4 groups: control, tailored print communication (TPC), telephone motivational interviewing (TMI), or combined (TPC + TMI). To analyze data from 469 participants, the authors constructed multi-sample structural equation models. Information processes mediated the effect of TMI and TPC + TMI on FVC. TMI had an indirect effect on FVC through relevance of the communications. TPC + TMI influenced FVC through perceived relevance of the communications, trust in the communications, and dose recall via two paths. In the first path, relevance was associated with trust. Trust was associated with recall, and greater recall predicted FVC. In the second path, relevance was associated with dose recall, and more recall predicted FVC. Thus, the authors found that key information processes mediated the relationship between a health communication intervention and FVC. Further research should investigate ways to enhance relevance, trust, and recall during the delivery of interventions.

An examination of sociodemographic, health, psychological factors, and fruit and vegetable consumption among overweight and obese U.S. veterans.

A diet high in fruits and vegetables (F&Vs) is associated with decreased risk for cardiovascular disease, diabetes, and cancer. This study investigated the relationship between sociodemographic, health, and psychosocial factors and F&V consumption among overweight and obese U.S. veterans. Participants were recruited from two Veterans Affairs medical center sites in 2005. Two hundred eighty-nine participants completed a self-administered survey. Bivariate and multivariate linear regression models were built to examine the association between sociodemographic, health, and psychosocial variables and F&V consumption. Older age (B = 0.01; p < 0.001) and being Black (B = -0.18; p < 0.05) were related to increased F&V consumption. Reported tobacco use was inversely associated with F&V consumption (B = -0.30; p < 0.01). Greater self-efficacy (B = 0.07; p < 0.05), fewer perceived barriers (B = -0.14; p < 0.01), and correct knowledge of recommended daily F&V intake (B = 0.12; p <0.05) were related to eating more F&Vs. U.S. veterans disproportionately experience overweight and obese conditions. Age, race, tobacco use, and psychosocial factors should be considered carefully when developing dietary interventionsamong overweight ana obese U.S. veterans.

Race moderates the relationship between obesity and colorectal cancer screening in women.

OBJECTIVE: To determine if the relationship between obesity and usage of colorectal cancer (CRC) screening in women varies when stratifying by race. METHODS: Using nationally representative data from the 2005 National Health Interview Survey, we examined the relationship between obesity and CRC screening for white and African-American women aged 50 and older. Screening usage variables indicated if a woman was up-to-date for any CRC screening test, colonoscopy, or FOBT. We used multivariable logistic regression models that included interaction terms to determine if race moderates the obesity-screening relationship. We also calculated adjusted up-to-date colonoscopy rates using direct standardization to model covariates. RESULTS: The relationship between obesity and screening differed by race for any CRC screening test (P = 0.04 for interaction) and for colonoscopy (P = 0.01 for interaction), but not for FOBT. Obese white women had a lower adjusted colonoscopy rate (30.2%, 95% CI 25.9-34.8) than non-obese white women (39.1%, 95% CI 36.1-42.2). Obese African-American women, on the other hand, had a higher adjusted colonoscopy rate (41.2%, 95% CI 31.6-51.4) than their non-obese counterparts (35.6%, 95% CI 28.3-43.6). Overall, adjusted colonoscopy rates were lowest among obese white women. CONCLUSIONS: Obesity is associated with lower CRC screening rates in white, but not African-American women.

A randomized clinical trial evaluating online interventions to improve fruit and vegetable consumption.

OBJECTIVES: We assessed change in fruit and vegetable intake in a population-based sample, comparing an online untailored program (arm 1) with a tailored behavioral intervention (arm 2) and with a tailored behavioral intervention plus motivational interviewing-based counseling via e-mail (arm 3). METHODS: We conducted a randomized controlled intervention trial, enrolling members aged 21 to 65 years from 5 health plans in Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota; Detroit, Michigan; and Atlanta, Georgia. Participants reported fruit and vegetable intake at baseline and at 3, 6, and 12 months. We assessed mean change in fruit and vegetable servings per day at 12 months after baseline, using a validated self-report fruit and vegetable food frequency questionnaire. RESULTS: Of 2540 trial participants, 80% were followed up at 12 months. Overall baseline mean fruit and vegetable intake was 4.4 servings per day. Average servings increased by more than 2 servings across all study arms (P<.001), with the greatest increase (+2.8 servings) among participants of arm 3 (P=.05, compared with control). Overall program satisfaction was high. CONCLUSIONS: This online nutritional intervention was well received, convenient, easy to disseminate, and associated with sustained dietary change. Such programs have promise as population-based dietary interventions.

Pilot weight control intervention among US veterans to promote diets high in fruits and vegetables.

BACKGROUND: Obesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans. METHODS: Using a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls. RESULTS: The intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (ß=0.15, p=0.01) and perceived the messages as important (ß=0.12, p<0.01) and applicable to their lives (ß=0.12, p<0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake. CONCLUSION: A tailored intervention can impact short term FV intake for obesity prevention.

Process evaluation results from the Eating for a Healthy Life study.

PURPOSE: Conduct a process evaluation of a low-fat, high-fruit/vegetable dietary intervention in religious organizations (ROs). The purpose of this process evaluation was to explore differences in healthy eating activities between the intervention and delayed control ROs and among the intervention ROs to identify the intervention activities most associated with dietary change. METHODS: Process data were collected via phone surveys and participation logs. A 12-month follow-up phone survey was conducted with an RO representative from intervention and delayed control ROs. The survey asked about healthy eating activities. Eating for a Healthy Life staff maintained participation logs of intervention RO participation in intervention activities: advisory board meetings, volunteer activities, healthy eating sessions, social events, dietary change mailings, print advertisements, and motivational messages. We used a stepwise regression model to determine which intervention activities were associated with changes in fat- and fiber-related dietary behaviors. RESULTS: RO member participation in advisory board meetings, social activities, and healthy eating sessions were associated with healthier fat- and fiber-related dietary behaviors. Greater RO attendance at advisory board meetings and greater numbers of healthy eating sessions at the RO were associated with decreased fat-related dietary behaviors (p < or = .05). Member participation in social activities was associated with more favorable fat, fruit, and vegetable intake. CONCLUSION: We successfully delivered an increased number of healthy activities at the intervention ROs and improved dietary-related behaviors.

The use of the pile sort method in identifying groups of healthful lifestyle behaviors among female community college students.

When encountering new or understudied populations, it is useful to build an understanding of the needs and perceptions of the target audience. This study investigated the application of the qualitative pile sort method for gaining information about nutrition and physical activity behaviors. In a pile sort, individuals make a list of topics relevant to a particular subject, and then they group these topics into related piles. This study investigated whether there was consistency in the ways in which participants grouped behaviors related to having a healthful lifestyle. Pile sorts were conducted during six focus groups among 28 female community college students (46% white; 39% had a 2-year degree or higher). A total of 74 piles of grouped behaviors were coded from the transcripts. Analyses revealed good consistency (identified nine to 12 times) for four groupings: exercise, lifestyle, how you eat, and positive foods. The pile sort method represents an activity that can be incorporated into formative research for interventions focused on complex behaviors with multiple components; in addition, this method may provide structure to counseling sessions and facilitate a better understanding of the perceptions of healthful eating and physical activity from patients' perspectives.

Multiple health behaviors among overweight, class I obese, and class II obese persons.

OBJECTIVES: Recent studies suggest an association between excess weightand increased risk of some cancers. Health disparities are evident for both obesity and cancer, each of which disproportionately affects African American adults. We examine the relationship between weight and selected health behaviors related to colorectal cancer (CRC) prevention (fruit and vegetable consumption, recreational physical activity, and CRC screening). We also examine behavioral psychosocial correlates including knowledge, perceived benefits and barriers, self-efficacy, and social support for these behaviors. METHODS: The WATCH (Wellness for African Americans through Churches) Project was a CRC prevention study implemented in African American churches in rural North Carolina. We analyzed the baseline data of 813 church members who provided information on their height and weight through a telephone-based survey. RESULTS: Most (78%) respondents were classified as overweight or obese. Self-rated health and level of physical activity were lower at higher weight levels, but little difference in fruit and vegetable consumption was observed among participants. Weight was negatively associated with past-year CRC testing among women but not among men. Levels of knowledge and self-efficacy were similar across weight groups, but some perceived barriers were significantly higher among obese participants. CONCLUSIONS: Obesity was associated with some health behaviors and psychosocial correlates associated with increased cancer risk. Cancer prevention programs in African American populations where overweight is prevalent may wish to specifically address these issues.

The relationship between the social environment within religious organizations and intake of fat versus fruits and vegetables.

The authors explored associations of social environment with dietary behavior among participants in the Eating for a Healthy Life study, a randomized, low-fat, high-fruit-and-vegetable dietary intervention trial in religious organizations. Data in this report are from baseline telephone surveys of 1,520 persons that assessed dietary behaviors (Fat- and Fiber-Related Diet Behavior Questionnaire) and social environment (Moos Group Environment Scale). After adjusting for demographic characteristics, higher scores on the Cohesion and Order/Organization subscales were associated with higher fruit/vegetable scores (indicating higher fruit and vegetable consumption). Higher scores on the Cohesion, Leader Support, and Order/Organization subscales were also associated with lower fat scores (indicating lower fat intake). Dietary behaviors within religious organizations may be related to positive perceptions of the social environment. These results support further exploration of the potential influence of religious organizations' social environment on health behaviors and its applicability to dietary change interventions.

Parents' and caregivers' concerns about obesity in young children: a qualitative study.

To address the childhood obesity epidemic, it is necessary to understand parents' and caregivers' concerns and beliefs regarding their children's weight problems and best practices for addressing those concerns. Formative research methods were used to identify obesity-related concerns of Hispanic, Black, and White parents of young children (5-8 years old) in North Carolina. Participants identified challenges at multiple levels of influence. In all groups, participants reported that they had trouble finding enough time to help their children develop healthy lifestyles. Conflicting family priorities and needs often made it difficult to ensure that their children had healthy diets. Children's own diet and activity preferences and their parent or caregiver's inability to adequately guide their choices also contributed to obesigenic behaviors. In addition, many thought that physician and community support for their efforts to manage their children's eating habits was inadequate. Findings from these focus groups suggest that participants would be receptive to positive, multilevel prevention approaches to help their children attain and maintain healthy weights.

"Una mujer trabaja doble aqui": Vignette-based focus groups on stress and work for Latina blue-collar women in eastern North Carolina.

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignette-based moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Knowledge, beliefs and barriers associated with prostate cancer prevention and screening behaviors among African-American men.

African-American men have the highest prostate cancer rates worldwide, and innovative efforts are needed to increase cancer prevention and screening behaviors among this population. Formative research was conducted to assess attitudes and behaviors linked to prostate cancer prevention activities that could be used to develop a culturally relevant intervention for an African-American church-based population. Four gender-specific focus groups were conducted with 29 men and women at two African-American churches in central North Carolina. Three primary themes emerged from the focus group discussions: culturally and gender-influenced beliefs and barriers about cancer prevention and screening; barriers related to the healthcare system: and religious influences, including the importance of spiritual beliefs and church support. These discussions revealed the importance of the black family, the positive influence of spouses/partners on promoting cancer screening and healthy behaviors, the roles of faith and church leadership, and beliefs about God's will for good health. These findings also revealed that there are still major barriers and challenges to cancer prevention among African Americans, including continued mistrust of the medical community and negative attitudes toward specific screening tests. Findings provide important insights to consider in implementing successful prostate cancer prevention interventions designed for church-based audiences.

Health behavior correlates among colon cancer survivors: NC STRIDES baseline results.

OBJECTIVE: To examine health behaviors (fruit/vegetable intake and physical activity) and their association with social cognitive theory (SCT) constructs among colorectal cancer (CRC) survivors (n=304) and comparable non-CRC-affected participants (n = 521). METHODS: Baseline data were analyzed bivariately and modeled with linear regression. Participants were 48% female, 36% African American (mean age = 67). RESULTS: Behaviors were comparable between groups, but survivors perceived more social support for behaviors (P <.05). Lack of employment was associated with greater frequency of healthy behaviors (P <.05) as were more modifiable factors including higher self-efficacy and lower barriers. CONCLUSIONS: SCT constructs were associated with behavior and may be targets for future interventions, but other variables may be important as well.

Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans.

Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n = 9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate-vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = .15) in PA for intervention (-0.30 MET-hours/week) compared with the comparison (-0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.