A 12-Week Randomized Intervention Comparing the Healthy US, Mediterranean, and Vegetarian Dietary Patterns of the US Dietary Guidelines for Changes in Body Weight, Hemoglobin A1c, Blood Pressure, and Dietary Quality among African American Adults.

BACKGROUND: The US Dietary Guidelines (USDG) form the basis of nutrition guidelines, but the research informing the 3 USDG dietary patterns (Healthy US-Style [H-US], Mediterranean [Med], and vegetarian [Veg]) has been drawn largely from observational studies among White populations. OBJECTIVES: The Dietary Guidelines 3 Diets study was a 3-arm, 12-wk randomly assigned intervention among African American (AA) adults at risk of type 2 diabetes mellitus that tested the 3 USDG dietary patterns. METHODS: The AAs (ages 18-65 y, BMI 25-49.9 kg/m2, and BMI was measured in kg/m2) with ≥3 type 2 diabetes mellitus risk factors were recruited. Weight, HbA1c, blood pressure, and dietary quality (healthy eating index [HEI]) were collected at baseline and 12 wk. In addition, participants attended weekly online classes that were designed using material from the USDG/MyPlate. Repeated measures, mixed models with maximum likelihood estimation, and robust computation of standard errors were tested. RESULTS: Of the 227 participants screened, 63 were eligible (83% female; age 48.0 ± 10.6 y, BMI 35.9 ± 0.8 kg/m2) and randomly assigned to the Healthy US-Style Eating Pattern (H-US) (n = 21, 81% completion), healthy Mediterranean-style eating pattern (Med) (n = 22, 86% completion), or healthy vegetarian eating pattern (Veg) (n = 20, 70% completion) groups. Within-group, but not between groups, weight loss was significant (-2.4 ± 0.7 kg H-US, -2.6 ± 0.7 kg Med, -2.4 ± 0.8 kg Veg; P = 0.97 between group). There was also no significant difference between groups for changes in HbA1c (0.03 ± 0.05% H-US, -0.10 ± 0.05% Med, 0.07 ± 0.06% Veg; P = 0.10), systolic BP (-5.5 ± 2.7 mmHg H-US, -3.2 ± 2.5 mmHg Med, -2.4 ± 2.9 mmHg Veg; P = 0.70), diastolic blood pressure (-5.2 ± 1.8 mmHg H-US, -2.0 ± 1.7 mmHg Med, -3.4 ± 1.9 mmHg Veg; P = 0.41), or HEI (7.1 ± 3.2 H-US, 15.2 ± 3.1 Med, 4.6 ± 3.4 Veg; P = 0.06). Post hoc analyses showed that the Med group had significantly greater improvements in HEI compared to the Veg group (difference = -10.6 ± 4.6; 95% CI: -19.7, -1.4; P = 0.02). CONCLUSIONS: The present study demonstrates that all 3 USDG dietary patterns lead to significant weight loss among AA adults. However, none of the outcomes were significantly different between groups. This trial was registered at clinicaltrials.gov as NCT04981847.

Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN).

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.

Assessing the Walkability Environments of Churches in a Rural Southeastern County of the United States.

CONTEXT: Churches can serve as important health promotion partners, especially in rural areas. However, little is known about the built environment surrounding churches in rural areas, including how these environments may impact opportunities for physical activity (PA) and may differ by neighborhood income levels. OBJECTIVE: This study described walkability around churches in a rural county and examined differences in church walkability between high-, medium-, and low-income neighborhoods. DESIGN: As part of the Faith, Activity, and Nutrition study, trained data collectors conducted a windshield survey of adjacent street segments within a half-mile of churches. SETTING: Churches (N = 54) in a rural southeastern county in the United States. MAIN OUTCOME MEASURE: A summary walkability score (eg, presence of sidewalks, safety features, low traffic volume) was created with a possible range from 0 to 7. Analysis of variance was used to assess differences in walkability of churches by neighborhood income levels. RESULTS: Walkability scores ranged from 0 to 6 (M = 2.31, SD = 1.23). Few churches had sidewalks, shoulders or buffers, or amenities nearby. In contrast, most churches had low traffic volume and no environmental incivilities. While not statistically significant, churches in low-income neighborhoods scored higher for walkability than churches in medium- and high-income neighborhoods. CONCLUSIONS: This study used low-cost environmental audits to analyze walkability in a sample of churches in a rural area and examined differences by neighborhood income. While churches may improve reach of people living in underserved and rural communities, a lack of environmental supports may limit effective PA promotion activities. Partnerships focused on improving existing areas or providing alternative PA opportunities for church and community members may be needed, especially in African American communities.

Objectively Measured Physical Activity and Sedentary Time Among Adults With and Without Stroke: A National Cohort Study.

Background and Purpose: We examined differences in the volume and pattern of physical activity (PA) and sedentary behavior between adults with and without stroke. Methods: We studied cohort members with an adjudicated or self-reported stroke (n=401) and age-, sex-, race-, region of residence-, and body mass index-matched participants without a history of stroke (n=1203) from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Sedentary behavior (total volume and bouts), light-intensity PA, and moderate-to-vigorous-intensity PA were objectively measured for 7 days via hip-worn accelerometer. Results: Sedentary time (790.5±80.4 versus 752.4±81.9 min/d) and mean sedentary bout duration (15.7±12.6 versus 11.9±8.1 min/d) were higher and PA (light-intensity PA: 160.5±74.6 versus 192.9±73.5 min/d and moderate-to-vigorous-intensity PA: 9.0±11.9 versus 14.7±17.0 min/d) lower for stroke survivors compared with controls (P<0.001). Stroke survivors also accrued fewer activity breaks (65.5±21.9 versus 73.31±18.9 breaks/d) that were shorter (2.4±0.7 versus 2.7±0.8 minutes) and lower in intensity (188.4±60.8 versus 217.9±72.2 counts per minute) than controls (P<0.001). Conclusions: Stroke survivors accrued a lower volume of PA, higher volume of sedentary time, and exhibited accrual patterns of more prolonged sedentary bouts and shorter, lower intensity activity breaks compared with persons without stroke.

Effective recruitment strategies for African-American men and women: the Nutritious Eating with Soul study.

Previous studies have found it challenging to recruit African-American (AA) participants into health education research studies. The goal of this article is to describe the recruitment methods used for the Nutritious Eating with Soul (NEW Soul) study, a 2-year randomized behavioral health education intervention, conducted in two cohorts, with emphasis on methods used for reaching men. Participants indicated how they learned about the study on an online screening questionnaire from a list of the recruitment strategies we employed. Due to limited recruitment of men in Cohort 1, recruitment strategies for Cohort 2 focused on reaching men. Across the two cohorts, a total of 568 (23% men) participants completed the online screener and 159 (21% men) completed all baseline assessments and enrolled in the study. The most effective methods for completing screening questionnaires were radio ads, referrals from friends and family, TV interviews, social media posts and community events. Men were primarily recruited via radio ads, whereas women were more often recruited through TV and social media. Radio was an effective way to recruit AA adults into nutrition interventions, particularly men. In addition, low-cost methods, such as personal referrals, social media posts and community events were also effective strategies.

Persistence and transience of food insecurity and predictors among residents of two disadvantaged communities in South Carolina.

BACKGROUND: Little is known about patterns of household food insecurity (HFI) across more than two time points in adults in the United States, the frequency predictors of different trajectories. The distinctions between persistent and transient food insecurity trajectories may be crucial to developing effective interventions. OBJECTIVE: To characterize dominant trajectories of food security status over three time points between 2013 and 2016 and identify demographic, socioeconomic and health-related predictors of persistent and transient HFI. DESIGN: Cohort study in disadvantaged communities in South Carolina. SETTING: and subjects: 397 middle-aged participants, predominantly female, African American, living in USDA-designated food deserts. MAIN OUTCOME MEASURE: Household food insecurity over time using the 18-item USDA's Household Food Security Survey Module. STATISTICAL ANALYSES PERFORMED: Descriptive analyses of food security trajectories and multinomial regression analyses. RESULTS: At baseline (2013-2014), 61% of households reported HFI during the previous 12 months, which decreased to 54% in 2015 and to 51% in 2016. Only 27% of households were persistently food secure, 36% experienced transient and 37% persistent food insecurity. Female sex (OR 2.7, 95%CI 1.2-5.9), being married or living with a partner (OR 2.4, 95CI% 1.1-5.3) and fair health status (OR 4.4, 95%CI 2.2-8.8) were associated with increased odds of persistent food insecurity. Fair health was also a significant predictor of transient food insecurity. CONCLUSIONS: These findings suggest that future research should focus on persistent versus transient trajectories separately and that tailored interventions may be needed to make progress on alleviating food insecurity among disadvantaged communities.

Program Implementation and Church Members' Health Behaviors in a Countywide Study of the Faith, Activity, and Nutrition Program.

Implementation research of health programs in faith-based organizations is lacking. The Faith, Activity, and Nutrition (FAN) program helps churches improve physical activity and fruit and vegetable behaviors of members. This study examined associations between implementation of FAN intervention components and church members' physical activity, fruit and vegetable behaviors, and self-efficacy for improving these behaviors. FAN was implemented in 35 churches in a southeastern US county. After attending in-person training, led by community health advisors, church committees received 12 months of telephone-delivered technical assistance to implement FAN according to 4 components: increasing opportunities, increasing guidelines and policies, increasing pastor support, and increasing messages for physical activity and healthy eating in their church. In this correlational study, FAN coordinators (n = 35) for each church reported baseline practices in 2015 and 12-month follow-up implementation of the 4 components for physical activity and healthy eating in 2016. Church members (n = 893) reported perceived implementation, physical activity and fruit and vegetable behaviors, and self-efficacy at 12-month follow-up in 2016. Independent variables were coordinator-reported baseline practices, baseline-adjusted 12-month implementation, and member-perceived 12-month implementation. Multilevel modeling examined associations between independent variables and member-reported 12-month physical activity and fruit and vegetable behaviors and self-efficacy. Coordinator-reported 12-month implementation of fruit and vegetable opportunities was associated with member fruit and vegetable consumption. Member perceptions at 12 months of church physical activity opportunities, pastor support, and messages were associated with higher self-efficacy for physical activity; pastor support and messages were positively associated with physical activity. Member perceptions at 12 months of fruit and vegetable opportunities, pastor support, and messages were associated with higher fruit and vegetable consumption and self-efficacy. Member-perceived implementation was more strongly associated with member behaviors than coordinator-reported implementation. Providing opportunities for healthy eating during already scheduled events may be an effective strategy for improving fruit and vegetable behavior.

Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States.

Objective: To examine diet quality and dietary intake among residents of disadvantaged neighborhoods in the Southeast United States (U.S.) and to examine associations between dietary and socioeconomic factors. Design: We examined baseline data from an evaluation study of a healthy food access initiative. Participants were recruited from two urban settings comprising seven neighborhoods of high household poverty (17% to 62%). Participants completed in-person interviews with measures of education, household income, and food security and one unannounced 24-hour dietary recall by telephone with trained registered dietitians. Food desert residence was coded based on U.S. Census data. Proportions meeting 2010 Dietary Guidelines for Americans and Healthy Eating Index 2010 (HEI-2010) scores were computed. Associations between dietary variables and participant's education, household income, food security, and food desert residence were tested. Results: Participants (n = 465) were predominantly African American (92%), women (80%), and overweight or obese (79%), and 52 ± 14 years of age. Sixty-three percent had low or very low food security, and 82% lived in census tracts of low income and low access to supermarkets (urban food desert). HEI-2010 scores averaged 48.8 ± 13.1. A minority of participants met dietary guidelines. Diet quality was lower among participants with lower education and among those from food insecure households (p < .05). Household income and food security were positively associated with meeting several dietary guidelines (p < .05). Food desert residence was unrelated to diet variables. Conclusions: In this disadvantaged population, significant nutritional concerns were observed, and socioeconomic factors were associated with diet quality and meeting dietary guidelines. Interventions must address broader economic, social, and policy issues such as access to affordable healthy foods.

Investigating Socioeconomic Disparities in the Potential Healthy Eating and Physical Activity Environments of Churches.

Faith-based settings have the potential to improve health in underresourced communities, but little research has quantified and compared health-promoting elements in church environments. This study examines the number of potential indoor and outdoor physical activity opportunities, healthy eating opportunities, healthy living media, and total environmental resources present in churches (n = 54) in a rural, southeastern US county and the relationship between these resources and neighborhood income. In our sample, most churches offered potential indoor and outdoor opportunities for physical activity and healthy eating opportunities, with more variability in the number of healthy living media items on display compared to other environmental components. Common potential opportunities present in churches for physical activity included a fellowship hall and green/open space, while potential opportunities for healthy eating frequently included a refrigerator and sink. Compared to those in medium- and high-income neighborhoods, churches in low-income neighborhoods scored higher on measures of potential outdoor physical activity opportunities and lower on measures of total potential environment resources, healthy eating opportunities, healthy living media, and indoor physical activity opportunities, though only indoor physical activity opportunities reached statistical significance. Potential opportunities for using existing resources in and around churches for health promotion should be investigated further, particularly in rural areas.

Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study.

BACKGROUND: Excessive sedentary time is ubiquitous in Western societies. Previous studies have relied on self-reporting to evaluate the total volume of sedentary time as a prognostic risk factor for mortality and have not examined whether the manner in which sedentary time is accrued (in short or long bouts) carries prognostic relevance. OBJECTIVE: To examine the association between objectively measured sedentary behavior (its total volume and accrual in prolonged, uninterrupted bouts) and all-cause mortality. DESIGN: Prospective cohort study. SETTING: Contiguous United States. PARTICIPANTS: 7985 black and white adults aged 45 years or older. MEASUREMENTS: Sedentary time was measured using a hip-mounted accelerometer. Prolonged, uninterrupted sedentariness was expressed as mean sedentary bout length. Hazard ratios (HRs) were calculated comparing quartiles 2 through 4 to quartile 1 for each exposure (quartile cut points: 689.7, 746.5, and 799.4 min/d for total sedentary time; 7.7, 9.6, and 12.4 min/bout for sedentary bout duration) in models that included moderate to vigorous physical activity. RESULTS: Over a median follow-up of 4.0 years, 340 participants died. In multivariable-adjusted models, greater total sedentary time (HR, 1.22 [95% CI, 0.74 to 2.02]; HR, 1.61 [CI, 0.99 to 2.63]; and HR, 2.63 [CI, 1.60 to 4.30]; P for trend < 0.001) and longer sedentary bout duration (HR, 1.03 [CI, 0.67 to 1.60]; HR, 1.22 [CI, 0.80 to 1.85]; and HR, 1.96 [CI, 1.31 to 2.93]; P for trend < 0.001) were both associated with a higher risk for all-cause mortality. Evaluation of their joint association showed that participants classified as high for both sedentary characteristics (high sedentary time [≥12.5 h/d] and high bout duration [≥10 min/bout]) had the greatest risk for death. LIMITATION: Participants may not be representative of the general U.S. population. CONCLUSION: Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, suggesting that physical activity guidelines should target reducing and interrupting sedentary time to reduce risk for death. PRIMARY FUNDING SOURCE: National Institutes of Health.

Physical activity outcomes in afterschool programs: A group randomized controlled trial.

INTRODUCTION: Afterschool programs (ASPs) across the US are working towards achieving the standard of all children accumulating 30min of moderate-to-vigorous physical activity (MVPA) during program time. This study describes the two-year impact of an intervention designed to assist ASPs meeting the 30min/day MVPA standard. METHODS: Using a two-year delayed treatment, group randomized controlled trial, 20 ASPs serving ~1700 children/year (6-12yrs) were randomized to either an immediate (n=10, baseline-2013 and 2yrs intervention fall-2013-to-spring-2015) or delayed group (n=10, baseline 2013-2014 and 1yr intervention fall-2014-to-spring-2015). The intervention, Strategies-To-Enhance-Practice (STEPs), focused on programming MVPA in the daily schedule, training of staff and leaders, and ongoing technical support/assistance. Accelerometry-derived proportion of children meeting the 30min/day MVPA standard was measured in the spring of each year. Mixed model logistic regressions were used to examine the change in the odds of achieving the MVPA standard. Analyses were conducted in 2015. Data were collected in one southeastern US state. RESULTS: Immediate boys (n=677) and delayed girls (n=658) increased the percent achieving 30min MVPA/day from 35.9% to 47.0% (odds ratio [OR]=1.88, 95% CI 1.18-3.00) and 13.1% to 19.1% (OR=1.42, 95% CI 1.03-1.96). Immediate girls (n=613) and delayed boys (n=687) exhibited a nonsignificant increase from 19.1% to 21.6% (OR=1.20, 95% CI 0.84-1.72) and 29.0% to 31.3% (OR=1.13, 95%CI 0.80-1.58). CONCLUSIONS: STEPs can have an impact on children's MVPA and time spent sedentary, yet was unable to fully achieve the goal of all children accumulating 30minMVPA/day. Additional efforts are need to identify strategies ASPs can use to meet this important public health standard.

Dietary Intake, Behaviors and Psychosocial Factors Among Women from Food-Secure and Food-Insecure Households in the United States.

OBJECTIVE: Determine whether macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake, and psychosocial and behavioral factors are associated with household food security. DESIGN: Baseline data from in-person interviews and telephone-based, 24-hour dietary recall from women recruited to a diet and physical activity controlled trial. SETTING: Neighborhoods encompassing 18 urban census tracts in South Carolina. PARTICIPANTS: Participants (n=202) were predominantly African American (87%), overweight or obese women aged 25 to 51 years with mean body mass index of 40.6±8.7. MAIN OUTCOME MEASURES: Macro- and micro-nutrient intake, energy intake, diet quality, adherence to recommended dietary intake (via multi-pass, 24-h recall); diet-related self-efficacy and social support, healthy/lowfat and emotional eating behaviors, and depressive symptoms. RESULTS: Women in food-secure (FS) and food insecure (FI) households were not different on health and sociodemographic characteristics. Women in FI households had lower self-efficacy and healthy/low-fat eating behaviors, and higher emotional eating and depressive symptoms compared with women in FS households. The groups did not differ on social support. Significant dietary differences were few (FS>FI on protein and lean meat; FS

Longitudinal associations with changes in outdoor recreation area use for physical activity during a community-based intervention.

Outdoor recreation areas (ORA) are important resources for physical activity (PA) and health promotion. While past research has identified correlates of ORA use, few studies have examined predictors of longitudinal changes in park- and trail-based PA in community settings. Using data from a 6-month community-based walking intervention study, we examined cross-sectional and longitudinal predictors of PA in ORAs. Data were collected from baseline and 6-month assessments from participants (n=295) in a group walking intervention in South Carolina; participants enrolled from January 2012-May 2013. A decomposition scheme was used to examine the cross-sectional and longitudinal predictors of average group ORA use for PA, including social support, self-efficacy for PA, perceptions of neighborhood environment, and accelerometer-based PA, adjusting for gender. On average, participants were 49.4+13.3years old, 66.1% were Black, and the majority were women. There was a mean increase in group ORA use of 2.1+0.4days/month from baseline to 6months. Cross-sectionally, higher levels of the percentage of time in MVPA, self-efficacy, and social support were associated with greater group-average ORA use. Longitudinally, increased social support from friends and rating of lighter motorized traffic were associated with increased group ORA use. Additionally, longitudinal increases in percentage of MVPA and more favorable rating of the neighborhood as a place to walk were both associated with decreased group ORA use. Better understanding how social and physical environmental characteristics impact ORA use for PA can lead to more effective intervention strategies and warrants greater attention in future research and public health promotion efforts.

Making healthy eating and physical activity policy practice: process evaluation of a group randomized controlled intervention in afterschool programs.

This study describes the link between level of implementation and outcomes from an intervention to increase afterschool programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30 min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified.

Identifying accelerometer nonwear and wear time in older adults.

BACKGROUND: Five accelerometer-derived methods of identifying nonwear and wear time were compared with a self-report criterion in adults ≥ 56 years of age. METHODS: Two hundred participants who reported wearing an Actical™ activity monitor for four to seven consecutive days and provided complete daily log sheet data (i.e., the criterion) were included. Four variables were obtained from log sheets: 1) dates the device was worn; 2) time(s) the participant put the device on each day; 3) time(s) the participant removed the device each day; and 4) duration of self-reported nonwear each day. Estimates of wear and nonwear time using 60, 90, 120, 150 and 180 minutes of consecutive zeroes were compared to estimates derived from log sheets. RESULTS: Compared with the log sheet, mean daily wear time varied from -84, -43, -24, -14 and -8 min/day for the 60-min, 90-min, 120-min, 150-min and 180-min algorithms, respectively. Daily log sheets indicated 8.5 nonwear bouts per week with 120-min, 150-min and 180-min algorithms estimating 8.2-8.9 nonwear bouts per week. The 60-min and 90-min methods substantially overestimated number of nonwear bouts per week and underestimated time spent in sedentary behavior. Sensitivity (number of compliant days correctly identified as compliant) improved with increasing minutes of consecutive zero counts and stabilized at the 120-min algorithm. The proportion of wear time being sedentary and absolute and proportion of time spent in physical activity of varying intensities were nearly identical for each method. CONCLUSIONS: Utilization of at least 120 minutes of consecutive zero counts will provide dependable population-based estimates of wear and nonwear time, and time spent being sedentary and active in older adults wearing the Actical™ activity monitor.

Patterns of sedentary behavior in overweight and obese women.

OBJECTIVES: Few studies have objectively quantified sedentary behavior, particularly in special population subgroups. This study quantified the volume of and breaks from sedentary behavior in a sample of overweight and obese, primarily African American, women. DESIGN: Cross-sectional. SETTING: 18 census tracts in Columbia, South Carolina with higher than state and national poverty levels. PARTICIPANTS: 197 overweight/obese women (87% African American). Mean age 38.3 +/- 7.6 years, mean body mass index 40.6 +/- 8.8 kg/m2. MAIN OUTCOMES MEASURES: Using a cut point of < 100 counts/minute, estimated daily averages of: 1) total volume, 2) > or = 10, 30, and 60-minute bouts, and 3) patterns of sedentary behavior according to time of day and day of the week were computed. Total breaks, or interruptions, in sedentary time were also calculated. RESULTS: Participants were sedentary 64.1% of the day, engaging in 10.5 +/- 2.8 daily bouts of sedentary behavior per hour of sedentary time; each bout lasted approximately 6.4 +/- 1.7 minutes. All participants engaged in > or = 1 daily bout of sedentary behavior > or = 10 and > or = 30 minutes, and most (83%) engaged in > or = 1 bout > or = 60 minutes. Participants were slightly more sedentary during the evening (6 pm-midnight) and on weekdays. On average, participants took 90.9 +/- 16.0 breaks from sedentary behavior; each break lasted 3.3 +/- .8 minutes. CONCLUSIONS: Women engaged in more sedentary behavior than that reported in national data sets. In an effort to improve public health, efforts should not only focus on increasing physical activity, but also on decreasing time spent sedentary.

Effect of a Plant-Based vs Omnivorous Soul Food Diet on Weight and Lipid Levels Among African American Adults: A Randomized Clinical Trial.

Importance: More African American individuals die from cardiovascular disease (CVD) than any other chronic disease condition. Despite this disparity, African American individuals are underrepresented in nutrition and CVD interventions. Objective: To compare the effects of an entirely plant-based (vegan) or low-fat omnivorous (omni) diet on change in body weight and lipids during a 2-year intervention. Design, Setting, and Participants: The Nutritious Eating With Soul (NEW Soul) study was a 2-year, randomized clinical trial conducted in 2 cohorts (2018-2020 and 2019-2021) that took place in a university teaching kitchen in Columbia, South Carolina (before March 2020), and via online videoconference sessions (after March 2020). Participants included African American adults aged 18 to 65 years with overweight or obesity (body mass index of 25.0-49.9) and without type 2 diabetes, uncontrolled thyroid disease, recent weight loss, or pregnancy. Data assessors and statisticians were blinded to study condition. Data analysis was performed from March to June 2022. Interventions: The intervention included weekly nutrition classes for 6 months biweekly classes for 6 months, and monthly classes for 12 months. Dietary interventions either emphasized no animal product intake (vegan) or a low-fat omnivorous diet (omni). Both dietary patterns emphasized soul food cuisine (traditional African American southern foodways). Main Outcomes and Measures: Primary outcomes included change in body weight and lipid measures at 12 months. Results: There were 568 participants who completed an online screening questionnaire; 409 were excluded and 159 were randomized (77 to the vegan group and 82 to the omni group). Of the 159 participants (mean [SD] age, 48.4 [10.6] years; 126 female [79%]) who began the study, the main outcome of body weight was obtained for 121 participants (76%) at 12 months. There were no differences in outcomes between groups, including 12-month changes in weight (mean, -2.39 kg [95% CI, -3.48 to -1.30 kg] for the vegan group vs -2.03 kg [95% CI, -3.07 to -1.00 kg] for the omni group; P = .64), total cholesterol (-1.05 mg/dL [95% CI, -9.60 to 7.50 mg/dL] for the vegan group vs 1.66 mg/dL [95% CI, -7.20 to 10.50 mg/dL] for the omni group; P = .67), or low-density lipoprotein cholesterol (mean, -2.56 mg/dL [95% CI, -9.52 to 4.40 mg/dL] for the vegan group vs -0.79 mg/dL [95% CI, -7.98 to 6.40 mg/dL] for the omni group; P = .73). Weight loss at 12 months among cohort 1, whose weight was assessed in 2019 before the COVID-19 pandemic, was significantly greater than that for cohort 2, whose weight was assessed summer 2020 during COVID-19 (-3.45 kg [95% CI, -4.67 to -2.22 kg] vs -1.24 kg [95% CI, -2.24 to -0.25 kg]; P = .01). Conclusions and Relevance: In this randomized clinical trial examining weight loss and CVD risk factor reduction among African American adults, there were no differences between the groups, and the magnitude of changes overall was small. Trial Registration: ClinicalTrials.gov Identifier: NCT03354377.

Effects of a lifestyle intervention on postpartum weight retention among women with elevated weight.

OBJECTIVE: The effectiveness of a pregnancy and postpartum behavioral lifestyle intervention on postpartum weight retention was examined. METHODS: Pregnant women with overweight and obesity in South Carolina were recruited into a theory-based randomized controlled trial (n = 112 intervention, n = 107 standard care), which was designed to reduce gestational weight gain and postpartum weight retention. RESULTS: Participants (44% African American, 56% White) had a mean prepregnancy BMI of 32.3 kg/m2 and were at 12.6 weeks' gestation at baseline. From prepregnancy to 6 months post partum, intervention participants retained less weight than standard care women (mean difference: -3.6 kg, 95% CI: -5.5 to -1.8). The intervention effect was maintained at 12 months post partum (mean difference: -2.4 kg, 95% CI: -4.3 to -0.5). Intervention women had 2.3 times higher odds of having no weight retention at 6 months post partum versus standard care women (95% CI: 1.2 to 4.4). Intervention participants also had lower odds of retaining ≥5% of their prepregnancy weight after delivery (adjusted odds ratio: 0.3, 95% CI: 0.1 to 0.5 at 6 months; adjusted odds ratio: 0.3, 95% CI: 0.2 to 0.6 at 12 months). CONCLUSION: This theory-based lifestyle intervention resulted in significantly less weight retention at 6 and 12 months after delivery among pregnant women with overweight and obesity.

Comparison of the Diet ID Platform to the Automated Self-administered 24-hour (ASA24) Dietary Assessment Tool for Assessment of Dietary Intake.

OBJECTIVE: Collecting multiple 24-hour recalls (24HR) can be burdensome, necessitating alternative methods to assess dietary intake in the research setting. METHOD: This cross-sectional study compared the use of the Diet ID™ online platform with three unannounced 24HR assessed via the Automated Self-Administered 24-Hour recall (ASA24) among participants in the Nutritious Eating with Soul (NEW Soul) study. NEW Soul participants (n = 68; 100% African American, 79% female, mean age 50.7 ± 9.6 years) were randomized to follow one of two healthy soul food diets: vegan or omnivorous. For the present study, data from both groups were combined. Energy intake, dietary quality (Healthy Eating Index), and macro-/micronutrient densities per 1000 kcals, as assessed by either the averaged values of the three 24HR or the Diet ID. Descriptive statistics (means, standard deviations, and Spearman rank correlations) summarized each nutrient as measured by the Diet ID and ASA24. Bland-Altman plots were used as the main method to assess agreement between the two measures. RESULTS: Nutrients from the Diet ID were generally higher than the 24HR except for the Healthy Eating Index (HEI) score (69.6 ± 12.2 ASA24 vs 51.1 ± 34.5 Diet ID). Diet ID reported 950 kcals higher energy intake than ASA24, with the difference being most pronounced at lower ASA24-reported energy intake. There were significant correlations among measures for HEI score, protein, carbohydrates, cholesterol, potassium, copper, thiamin, and vitamins B12 and E. There was higher reporting of nutrients using Diet ID compared to the 24HR. Diet ID is a rapid way to assess dietary intake. CONCLUSIONS: Future studies should consider comparing these two methods with objective assessments of energy and nutrient intake and using multiple instruments to ensure that the strengths of all methods are included.

Socially Distanced Data Collection: Lessons Learned Using Electronic Bluetooth Scales to Assess Weight.

Introduction. Electronic Bluetooth scales (e-scales) may be useful for remote weight assessment. This study analyzed predictors of engagement with e-scales and feasibility for remote weight assessment. Method. Due to COVID-19 restrictions, participants (n = 150, 100% African American, 79% female, average age 48.2 ± 10.6 years) in an ongoing trial were invited to receive an e-scale. Participants had 1 month to complete a weigh-in. Email, text, and phone call reminders were sent. Data were analyzed using descriptive approaches and logistic regression. Results. Seventy-five participants (50% of sample) elected to receive an e-scale. Older participants (t = -2.01, p = .05) and a greater proportion of females (χ2 = 7.8, p < .01) signed up to receive an e-scale. An average of 2.6 ± 1.3 reminders was required. Most participants who received an e-scale completed a weigh-in (n = 70). Discussion. Half the sample elected to receive an e-scale. Strategies to increase willingness among men and younger adults to sign up to receive an e-scale are needed.