The Results of the "Positive Action for Today's Health" (PATH) Trial for Increasing Walking and Physical Activity in Underserved African-American Communities.

BACKGROUND: The "Positive Action for Today's Health" (PATH) trial tested an environmental intervention to increase walking in underserved communities. METHODS: Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62% females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. RESULTS: There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. CONCLUSIONS: Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).

Neighborhood Social Predictors of Weight-related Measures in Underserved African Americans in the PATH Trial.

African Americans have the highest rate of obesity in the United States relative to other ethnic minority groups. Bioecological factors including neighborhood social and physical environmental variables may be important predictors of weight-related measures specifically body mass index (BMI) in African American adults. Baseline data from the Positive Action for Today's Health (PATH) trial were collected from 417 African American adults. Overall a multiple regression model for BMI was significant, showing positive associations with average daily moderate-to-vigorous physical activity (MVPA) (B =-.21, P<.01) and neighborhood social interaction (B =-.13, P<.01). Consistent with previous literature, results show that neighborhood social interaction was associated with healthier BMI, highlighting it as a potential critical factor for future interventions in underserved, African American communities.

A longitudinal study of the effects of instrumental and emotional social support on physical activity in underserved adolescents in the ACT trial.

BACKGROUND: Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents. PURPOSE: This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers. METHODS: Students in the sixth grade (N = 1,422, 73 % African American, 54 % female, M age = 11 years) in the ACT trial participated. At baseline and 19 weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates. RESULTS: A mixed ANCOVA demonstrated that baseline (p = 0.02) and change in family instrumental support (p = 0.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period. CONCLUSIONS: Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.

Barriers to Optimal Child Sleep among Families with Low Income: A Mixed-Methods Study to Inform Intervention Development.

This study gathered formative data on barriers to optimal child sleep to inform the development of a sleep intervention for parents of preschool-aged children in low-income households. Parents (n = 15, age: 34 ± 8 years, household income: $30,000 ± 17,845/year) reporting difficulties with their child's sleep participated in this study. Mixed methods included an online survey and semi-structured phone interview. Items assessed barriers/facilitators to optimal child sleep and intervention preferences. Interview transcripts were coded using inductive analyses and constant-comparison methods to generate themes. Derived themes were then mapped onto the Theoretical Domains Framework to contextualize barriers and inform future intervention strategies. Themes that emerged included: stimulating bedtime activities, child behavior challenges, variability in children's structure, parent work responsibilities, sleep-hindering environment, and parent's emotional capacity. Parent's intervention preferences included virtual delivery (preferred by 60% of parents) to reduce barriers and provide flexibility. Mixed preferences were observed for the group (47%) vs. individual (53%) intervention sessions. Parents felt motivated to try new intervention strategies given current frustrations, the potential for tangible results, and knowing others were in a similar situation. Future work will map perceived barriers to behavior change strategies using the Behavior Change Wheel framework to develop a parenting sleep intervention.

Stability of mental disorder prevalence estimates among school-aged children and adolescents: findings from the community-based project to learn about youth-mental health (PLAY-MH) and replication-PLAY-MH (Re-PLAY-MH), 2014-2017.

PURPOSE: This study evaluated the stability over time of prevalence estimates of mental disorders among school-aged children from the same community. METHODS: We compared screening status and weighted prevalence of selected mental disorders from the two-stage school-based South Carolina Project to Learn About Youth-Mental Health (Time 1) and its replication study (Time 2) conducted between 2014 and 2017. During stage 1, two teacher screeners were used to group students into high or low risk for a mental disorder. During stage 2, parents of selected students completed a structured diagnostic interview to assess whether their child met criteria for specific disorders. RESULTS: For stage 1, 19.9% of students screened as high risk for a mental disorder at Time 2 compared to 17.8% at Time 1. Among students included at both timepoints, 9.1% screened as high risk at both timepoints while screening status changed for 20.7%. The overall prevalence of included mental disorders was approximately 18% at both time points There were no differences (P-values >.05) in prevalence of individual mental disorders between Time 1 (range:0.3%-6.7%) and Time 2 (range:1.2%-7.7%). CONCLUSIONS: Study findings demonstrate that similar methodology yielded similar prevalence estimates of mental disorders and can inform community-level planning for improving mental health in children.

The Factor Structure and Gender Invariance of ADHD Symptoms in College Students.

Previous studies examining the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in adults using self-report measures have shown mixed results, supporting two-, three-, and bifactor solutions. The current study further investigated the structure of ADHD symptoms in adults using the Current Symptoms Scale and rigorous model evaluation in a sample of 892 college students. Confirmatory factor analysis was used to analyze and compare five-factor structures; a single-factor model, a two-factor model, a three-factor model, and two bifactor models. A single-factor model with correlated residuals best fit the data. Factor correlations with nearly all related constructs (i.e., symptoms of oppositional defiant disorder, depression, impairment, previous ADHD diagnosis, grades, and substance use) were significant in the expected directions and the model was invariant across gender. These findings contribute to a growing body of work suggesting a unidimensional factor may best represent ADHD symptoms in adults. Implications are discussed.

Revisiting the Effect of Varying the Number of Response Alternatives in Clinical Assessment: Evidence From Measuring ADHD Symptoms.

This study illustrated the effect of varying the number of response alternatives in clinical assessment using a within-participant, repeated-measures approach. Participants reported the presence of current attention-deficit/hyperactivity disorder symptoms using both a binary and a polytomous (4-point) rating scale across two counterbalanced administrations of the Current Symptoms Scale (CSS). Psychometric properties of the CSS were examined using (a) self-reported binary, (b) self-reported 4-point ratings obtained from each administration of the CSS, and (c) artificially dichotomized responses derived from observed 4-point ratings. Under the same ordinal factor analysis model, results indicated that the number of response alternatives affected item parameter estimates, standard errors, goodness of fit indices, individuals' test scores, and reliability of the test scores. With fewer response alternatives, the precision of the measurement decreased, and the power of using the goodness-of-fit indices to detect model misfit decreased. These findings add to recent research advocating for the inclusion of a large number of response alternatives in the development of clinical assessments and further suggest that researchers should be cautious about reducing the number of response categories in data analysis.

Stand-Alone Social Skills Training for Youth with ADHD: A Systematic Review.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, and its symptoms and impairment in multiple domains begin in childhood and can extend into adulthood as well. Many youth with ADHD experience impairment in the social domain, including social skills deficits and difficulties in peer relationships. Social skills interventions, or social skills training (SST), have been developed to target social impairment and improve the social skills and functioning of youth with ADHD. Previous reviews of SST for youth with ADHD have provided mixed conclusions, with many including comprehensive, multilevel interventions for ADHD and none examining stand-alone SST for ADHD in a systematic way. The present review addresses this gap in the literature by providing the first known comprehensive, systematic review of SST alone, along with ratings of methodological rigor for each evaluation of stand-alone SST. The present review provides insight into the strengths and weaknesses in the existing SST literature, and provides suggestions for improvement and future directions for SST. An outline of "specific ingredients" and characteristics of effective SST are also presented, with the goal of providing both researchers and clinicians guidance for creating and implementing effective SST for youth with ADHD.

Is ADHD, independent of ODD, associated with whether and why college students misuse stimulant medication?

Although previous research suggests that undergraduates with untreated or undertreated attention-deficit/hyperactivity disorder (ADHD) symptoms may have academic motives for stimulant medication misuse, no previous work has examined the relation of ADHD symptoms, controlling for comorbid oppositional defiant disorder (ODD), to misuse, or has explored how these symptoms are differentially related to motives for misuse. Among a sample of 900 students from one public university, the current study first tested whether increased ADHD symptomology (using the Current Symptoms Scale, CSS) was associated with an increased likelihood of misusing stimulant medication, controlling for comorbid ODD. We then examined whether those with increased ADHD symptomology were more likely to report academic motives for misuse. The prevalence rate of misuse in the past year was 22%. Participants who met symptom count criteria for ADHD (controlling for comorbid ODD) were 2.90 times more likely to misuse stimulant medication than those who did not. Among misusers, those who met ADHD criteria were also 2.80 times more likely to report academic motives for misuse. These results support that stimulant medication misuse is likely driven, in part, by inadequate or absent care for the executive functioning impairments associated with ADHD. Therefore, a greater focus on assessment and treatment of college students with ADHD symptoms is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families.

BACKGROUND: The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. DESIGN AND SETTING: The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M + FWL (Motivational Plus Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M + FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. INTERVENTION: The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.

Physical activity as a mediator linking neighborhood environmental supports and obesity in African Americans in the path trial.

OBJECTIVE: African Americans have the highest rates of obesity in the United States. Engaging in recommended levels of physical activity (PA) reduces risk for obesity. Social and environmental supports for PA may be important to increase PA. This study hypothesized that PA would mediate the effects of neighborhood and social supports for PA on body mass index (BMI). METHOD: Baseline data were collected from 434 underserved African American adults in the Positive Action for Today's Health (PATH) trial. Features of the neighborhood environment (i.e., infrastructure for walking, access to services, and crime) and peer social support were measured with validated surveys. Moderate-to-vigorous PA (MVPA) was assessed based on 7-day accelerometry estimates (in minutes per day), and self-reported walking and exercise were obtained using the Four-Week Physical Activity History questionnaire. RESULTS: The sample was predominantly female (63%) and obese (MBMI = 30.88 kg/m², SD = 8.43). Neither crime nor social support was significantly associated with either PA or BMI; thus, they were excluded from the final models. Infrastructure for walking predicted MVPA (B = 4.06, p = .01) and self-reported walking (B = 7.39, p = .03). A positive association between access to services and MVPA approached significance (B = 2.27, p = .06). MVPA (B = -0.07, p < .001) and self-reported walking (B = -0.02, p = .01) predicted BMI, but only MVPA mediated the effect of infrastructure for walking on BMI (B = -0.03, p = .04). No significant direct or indirect effects of predictors were found for self-reported exercise. CONCLUSION: Findings suggest that MVPA is a mediator linking infrastructure for walking and BMI in underserved communities.