Cardiorespiratory fitness and mortality in diabetic men with and without cardiovascular disease.

We assessed joint associations of cardiorespiratory fitness and diabetes, cardiovascular disease (CVD), or both with all-cause mortality. High-fitness eliminated mortality risk in diabetes (P<0.001) and halved risk of death in diabetes/CVD (P<0.001). Fitness was a potent effect modifier in the association of diabetes and CVD to mortality.

Physical activity belief scales for diabetes risk: development and psychometric testing.

This article describes the development and psychometric evaluation of behavioral belief, normative belief, and control belief scales, derived from the theory of planned behavior to predict physical activity intentions of persons at risk for diabetes. In Study 1, belief statements from interviews were categorized, ranked, and evaluated for item construction. Content validity was established by 96.1% agreement among a five-member expert panel. In Study 2, items developed from the belief statements were administered to 106 adults at risk for diabetes. Psychometric analyses provided evidence of construct validity and reliability of the three scales. Internal consistency was sufficient (alpha = .76-.95), and test-retest evaluations indicated scale stability (r = .79-.91). Factor analyses and confirmatory factor analysis using structural equation modeling provided evidence that the items were appropriately grouped under each construct. Researchers and practitioners can use these measures to assess behavioral, normative, and control beliefs about physical activity among persons at risk for diabetes.

Perceived milk intolerance is related to bone mineral content in 10- to 13-year-old female adolescents.

OBJECTIVE: The purpose of this study was to determine associations among lactose maldigestion status, perceived milk intolerance, dietary calcium intake, and bone mineral content in early adolescent girls. METHODS: Subjects were 291 girls who participated in a substudy of the multiple-site project Adequate Calcium Today. Lactose maldigestion status was determined with hydrogen breath testing, and questionnaires were used to assess perceived milk intolerance. Dietary calcium intake was estimated from a semiquantitative food frequency questionnaire. Anthropometric and dual-energy x-ray absorptiometric measurements (total body, spine L2-L4, total hip, and hip femoral neck) were standardized across sites. RESULTS: Of the 230 girls who completed breath hydrogen testing, 65 were Asian, 76 were Hispanic, and 89 were non-Hispanic white. A total of 100 girls experienced increases in breath hydrogen levels of >20 ppm and were classified as lactose maldigesters. Of the 246 participants who completed useable perceived milk intolerance questionnaires, 47 considered themselves to be milk intolerant. Of the 47 girls self-reporting perceived milk intolerance, 40 completed breath hydrogen testing and 22 were not maldigesters. Girls with perceived milk intolerance consumed an average of 212 mg of total food calcium per day less than girls without perceived milk intolerance. Spinal bone mineral content was significantly lower in the girls with perceived milk intolerance, compared with the girls without perceived milk intolerance. When girls with lactose maldigestion were compared with girls without lactose maldigestion, there were no significant differences in calcium intake or bone measures. CONCLUSIONS: These results suggest that, starting as early as 10 years of age, self-imposed restriction of dairy foods because of perceived milk intolerance is associated with lower spinal bone mineral content values. The long-term influence of these behaviors may contribute to later risk for osteoporosis.

Body mass index and percentage body fat as health indicators for young adults.

OBJECTIVES: To investigate the validity of an axiom that body mass index (BMI) and percentage body fat (%BF), above an ideal, are health risk factors. METHODS: Participants were 2615 volunteers who participated in a health-screening program conducted in college residence halls over a consecutive 8-year period. RESULTS: Nearly half of all participants were misclassified when BMI and/or %BF were used to define better versus poorer health whether analyzing all variables together, by individual factor, or by type of variable. CONCLUSIONS: Results of this study indicate that BMI and %BF are poor indicators of health status among young adults.

Physical activity and function in older adults: theory of planned behavior.

OBJECTIVE: To assess the theory of planned behavior (TPB) and TPB with functional ability to explain intention and self-reported physical activity (PA) behavior of older adults. METHODS: A survey was mailed to 2056 retirees from a large Midwestern university. RESULTS: Structural equation modeling revealed that the TPB plus functional ability explained an additional 11% variance than the TPB alone in older adult PA and functional ability was the best predictor of PA (beta = .53, P<.05). CONCLUSIONS: Functional ability appears to be an important predictor of PA behavior and should be included when designing PA programs for older adults.

Does the theory of planned behavior identify diabetes-related cognitions for intention to be physically active and eat a healthy diet?

UNLABELLED: Diabetes, a major public health problem, can be prevented or delayed with physical activity and diet modifications, but this requires changing behavior. Understanding the beliefs of persons at risk for diabetes may result in more effective and efficient behavior change interventions. OBJECTIVE: To explore the utility of the Theory of Planned Behavior (TPB) and perceived diabetes risk for identifying modifiable diabetes-related beliefs for behavior change. DESIGN: Descriptive survey based on the TPB and perceived risk. SAMPLE: Convenience sample included 106 adults at risk for diabetes. MEASUREMENTS: Mailed questionnaire with scales to measure TPB variables. RESULTS: Subjective norm and perceived behavioral control were related to intention to be physically active, and attitude, subjective norm, and perceived behavioral control were related to intention to eat a healthy diet. Perceived diabetes risk was not related to intention to be physically active or eat a healthy diet. CONCLUSIONS: The TPB is a useful theory in explaining physical activity and healthy eating intentions in persons at risk for diabetes. The relationship of perceived diabetes risk and intentions to be physically active and eat a healthy diet needs further investigation.

Psychometric properties of the healthful eating belief scales for persons at risk of diabetes.

OBJECTIVE: To examine the validity and reliability of Theory of Planned Behavior (TPB) scales for healthful eating for persons at risk for diabetes. DESIGN: Cross-sectional, using a self-administered questionnaire. SETTING: Community in the Midwest. PARTICIPANTS: 106 adults who self-identified based on one or more American Diabetes Association diabetes risks. VARIABLES MEASURED: Behavioral, normative, and control beliefs; and attitude, subjective norm, perceived behavioral control, and intention to eat a healthful diet. ANALYSIS: Construct validity was assessed with factor analyses and measurement and structural models using structural equation modeling. Reliability of the scales was assessed with Cronbach alpha and a 2-month test-retest. RESULTS: Factor analysis loadings were greater than .37. Cronbach alphas for the behavioral, normative, and control belief scales were .80, .91, and .84, respectively. The measurement model revealed that the measures were significant estimates for the TPB constructs, and they fit well as indirect measures of attitude, subjective norm, and perceived behavioral control in predicting intention to eat a healthful diet. Test-retest revealed 2-month stability of the scales. CONCLUSIONS AND IMPLICATIONS: Scales for measuring TPB behavioral, normative, and control beliefs were valid and reliable for use with adults at risk for diabetes. Further examination with minority persons is warranted.

A vision for doctoral research training in health behavior: a position paper from the American Academy of Health Behavior.

OBJECTIVE: To establish and disseminate the position of the American Academy of Health Behavior (The Academy) on doctoral research training. METHODS: A collaborative process involving the Work Group on Doctoral Research Training with input from The Academy membership led to the development of the guidelines described herein. RESULTS: A set of guidelines is provided that describe the process of learning to be a scholar/researcher and the outcomes of learning the practice of health behavior research. CONCLUSIONS: The doctoral students who are to become the stewards of our field should be prepared to engage in scholarship that creates new knowledge, uses research to transform practice, and effectively communicates research findings.

Synthesis of intervention research to modify physical activity and dietary behaviors.

A descriptive literature review was conducted to examine conceptual and methodological issues of interventions aimed at improving both physical activity and diet behaviors according to critical elements established by Sidani and Braden (1998). The method of the review of 30 articles describing 17 intervention studies focused on the following nine elements: (a) relevance of the intervention to the targeted outcome; (b) theoretical components of the intervention; (c) intervention components; (d) complexity, strength, and integrity of the intervention; (e) extraneous factors; (f) adherence to the intervention and retention; (g) reliability and validity of the outcome measures; (h) expected outcomes; and (i) effectiveness of the intervention. The results were that the interventions were relevant and included multiple components, but most interventions lacked an explicit theoretical framework. Adherence to the intervention and retention were problems. Overall, to varying degrees and for those completing the programs, the interventions were effective for increasing physical activity, lowering dietary fat, weight loss, and reducing risk for illness. Twelve "lessons learned" evolved that have practical and research implications. One salient lesson and future priority is to incorporate theory to reveal the intervention content and mechanisms to modify physical activity and dietary behaviors concurrently so that future interventions are more efficacious and efficient. Another lesson revealed the need for more sensitive measures, and examination of ways to improve intervention adherence and retention and prevent relapse.

The development of an ergonomics training program to identify, evaluate, and control musculoskeletal disorders among nursing assistants at a state-run veterans' home.

Nursing assistants (NAs) who work in nursing and personal care facilities are twice and five times more likely, respectively, to suffer a musculoskeletal disorder compared to service industries and other health care facilities, respectively. The purpose of this study was to develop an ergonomics training program for selected NAs at a state-run veterans' home to decrease musculoskeletal disorders by 1) developing questionnaires to assess musculoskeletal stress, 2) evaluating the work environment, 3) developing and using a training package, and 4) determining the application of the information from the training package by NAs on the floor. Results show two new risk factors not previously identified for nursing personnel in the peer-reviewed literature. Quizzes given to the nursing personnel before and after training indicated a significant improvement in understanding the principles of ergonomics and patient-handling techniques. Statistical analysis comparing the pre-training and post-training questionnaires indicated no significant decrease in musculoskeletal risk factors and no significant reduction in pain or discomfort or overall mental or physical health.

Change in diet, physical activity, and body weight in female college freshman.

OBJECTIVE: To examine diet, physical activity, and body-weight changes associated with relocation from home to university. METHODS: Diet, fitness/physical activity, body-weight parameters and self-efficacy were assessed among 54 freshman women upon college entry and 5 months later. RESULTS: Although caloric intake significantly decreased, a significant increase occurred in body-weight parameters that may be attributed to significant decreases in total physical activity. CONCLUSIONS: Interventions are needed aimed at increasing physical activity; improving diet quality related to consumption of vegetables, fruits, breads and pasta, and meats; and decreasing alcohol consumption.

Beliefs of blue-collar workers: stage of readiness for exercise.

OBJECTIVE: To address a theoretical debate regarding contributions of self-efficacy and the theory of planned behavior (TPB) in explaining the amount of variance in stage of readiness to exercise among blue-collar workers. METHOD: A validated questionnaire was used for assessment. RESULTS: LISREL indicated that self-efficacy had the most influence on stage and TPB constructs were subjugated to self-efficacy. Univariate analyses indicated that self-efficacy and TPB variables are important for intervention. CONCLUSIONS: Self-efficacy plays a major role in explaining exercise stage among high-risk blue-collar workers, and self-efficacy and TPB constructs are important to consider in designing interventions.

Predictors of influenza vaccine. Acceptance among healthy adult workers.

A self administered questionnaire with items derived from the Health Belief Model was mailed to a random sample of workers prior to a worksite influenza vaccine program in this descriptive study of 207 service and clerical workers. The researchers investigated the utility of the Health Belief Model in predicting influenza vaccine acceptance. A second postcard questionnaire was mailed after the program to verify the vaccination status. Workers who received the vaccine had higher scores for susceptibility, seriousness, benefits, cues to action, knowledge, and health motivation and lower scores for barriers than did workers who did not receive a vaccine. Logistic regression analysis revealed the importance of benefits, barriers, and cues to action in predicting influenza vaccine acceptance. Study results suggest education and program efforts directed toward increasing benefits, dispelling myths about influenza and the vaccine, reducing barriers, and developing a campaign to increase program awareness may increase workers' vaccine acceptance.

Corporate social marketing: message design to recruit program participants.

OBJECTIVE: To identify variables for a corporate social marketing (SM) health message based on the 4 Ps of SM in order to recruit future participants to an existing national, commercial, self-administered weight-loss program. METHOD: A systematically evaluated, author-developed, 310-response survey was administered to a random sample of 270 respondents. RESULTS: A previously established research plan was used to empirically identify the audience segments and the "marketing mix" appropriate for the total sample and each segment. CONCLUSIONS: Tangible product, pertaining to the unique program features, should be emphasized rather than positive core product and outcome expectation related to use of the program.