Association of neighborhood Walk Score with accelerometer-measured physical activity varies by neighborhood socioeconomic status in older women.

The built environment can influence physical activity behavior. Walk Score is a widely used measure of the neighborhood built environment to support walking. However, studies of the association between Walk Score and accelerometer-measured physical activity are equivocal and no studies have examined this relationship among older adults. We analyzed data from a large, diverse sample of women (n = 5650) with a mean age of 79.5 (SD = 6.7) at time of accelerometry wear in the Women's Health Initiative Objective Physical Activity Cardiovascular Health Study in the United States to examine associations between neighborhood Street Smart Walk Score (SSWS) and accelerometer-measured physical activity. Participants wore triaxial accelerometers for seven days and SSWS was determined from home addresses. 67 % of the sample lived in "car-dependent" locations (SSWS 0-49 out of 100); only 3 % lived in "walker's paradise" locations (SSWS 90-100). The multivariable model indicated an association between SSWS and accelerometer-measured physical activity (steps/day) in the total sample. The association varied by neighborhood socioeconomic status; in high socioeconomic status neighborhoods, higher SWSS was associated with greater steps per day, while no significant association between SWSS and physical activity was observed in low socioeconomic neighborhoods. This study should catalyze furtherresearch regarding the utility of SSWS in determining neighborhood walkability for older women across different neighborhood settings and suggests other built environment factors must be considered when determining walkability. Future studies should examine what factors influence walkability and develop age-relevant methods to assess and characterize neighborhood walkability.

Evaluation of free-floating bike-share on a university campus using a multi-method approach.

Bike-sharing, especially free-floating bike-share, has tremendous potential for increasing active transport on a college campus. Increased bike use improves public health, reduces pollution, and solves traffic congestion problems. Like other innovations, free-floating bikeshare proceeds through various stages while disseminated and before being widely adopted and accepted. A multi-method study using quantitative bike usage data, a cross-sectional survey, and focus group discussions was used to evaluate the Spring 2018 launch of a free-floating bike-share program at a large public university. Three months after implementation, there were 19,504 registered users, 24,371 different riders, 165,854 rides, and 85,778 miles traveled. The average trip length was 0.52 miles and lasted 8.3 min. Survey data from 2845 students, faculty, and staff revealed that 33.6% had used the bikes. Bike users were more likely to be students, freshmen, living on campus, be a current biker, and have confidence in their biking ability. Focus groups revealed that safety was a concern, knowledge about how the program worked was low among non-users and faculty and staff, cost was a barrier, and that adherence to bike-share rules needed to be improved. A large segment of the university population quickly adopted free-floating bike-share. However, continued work needs to be done to enhance safety, provide clear guidelines on bike-share rules (e.g., bike parking), and increase knowledge of the program with a specific focus on use by faculty and staff to ensure continued success and ultimately improve health.

Mapping the Possibilities: Using Network Analysis to Identify Opportunities for Building Nutrition Partnerships Within Diverse Low-Income Communities.

OBJECTIVE: To identify communication and collaboration patterns among organizations involved in nutrition education within an ethnically diverse low-income community. DESIGN: A snowball sample methodology was used to identify 27 organizations involved in nutrition activities in the community. The researchers conducted an online survey and network analysis to identify communication and collaboration patterns among these organizations. SETTING: An urban neighborhood in Honolulu, HI. PARTICIPANTS: Individuals responsible for nutrition activities at state, county, and nonprofit organizations. MAIN OUTCOME MEASURES: Network structure, betweenness, and centralization. ANALYSIS: Communication was uncentralized and collaboration was limited. Collaboration was affected by differences in mission, location, and population served. Child care/youth development organizations and community health centers provided links across the community. Agencies serving different ethnic populations were poorly linked and located on the periphery of the network. Ethnic-specific churches expressed strong interest in nutrition partnership but were not identified as potential partners by other agencies in the network. CONCLUSIONS AND IMPLICATIONS: Limited communication between agencies serving different populations in the same community may result in missed opportunities for collaboration. Network analysis is an effective tool for identifying these gaps and helps build community capacity for improving nutrition outcomes.

Baseline results from Hawaii's Na Mikimiki Project: a physical activity intervention tailored to multiethnic postpartum women.

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Na Mikimiki ("the active ones") Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2-12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008-2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian-American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Na Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women.

Health-promoting and health-risk behaviors: theory-driven analyses of multiple health behavior change in three international samples.

BACKGROUND: Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer. PURPOSE: To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors. METHOD: Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses. RESULTS: Consistently stronger correlations were found between nutrition and physical activity (r = 0.16-0.26, p < 0.01) than between non-smoking and nutrition (r = 0.08-0.16, p < 0.03), or non-smoking and physical activity (r = 0.01-0.21). Principal component analyses of investigated behaviors indicated two factors: a "health-promoting" factor and a "health-risk" factor. Three distinct behavioral patterns were found in the cluster analyses. CONCLUSION: Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors--especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors.

Liability concerns and shared use of school recreational facilities in underserved communities.

BACKGROUND: In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. PURPOSE: The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. METHODS: A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. RESULTS: The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. CONCLUSIONS: Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours.

Correlates of park-based physical activity among children in diverse communities: results from an observational study in two cities.

PURPOSE: This study examined correlates of park-based physical activity (PA) among children in neighborhood parks. DESIGN: Direct observation was used to assess PA among children. SETTING: Public parks in Tampa, Florida (n=10), and Chicago, Illinois (n=18), from low income and high income and racially/ethnically diverse communities. Subjects. Children (n=3410), coded as anyone who appeared to be 10 years or younger, observed at parks in Tampa and Chicago. MEASURES: Physical activity was measured by a modified version of the System for Observing Play and Leisure Among Youth (SOPLAY). ANALYSIS: Descriptive statistics and multilevel regression models were used in data analysis. RESULTS: At the activity observation level, children's PA was positively related to temperature and unstructured activities in Tampa and Chicago parks. Among park activity area predictors, type of activity area was significantly related to PA. In Tampa, more PA was observed on courts, and less PA was observed in shelter areas compared with open space areas. In Chicago, less PA was observed on courts and fields compared with open space areas. Neighborhood income was associated with lower PA in Tampa parks. Neighborhood race/ethnicity was not a significant predictor of children's PA in either city. CONCLUSIONS: Children's PA was linked to modifiable social and environmental features within parks. Strategies to increase PA among children in parks should promote courts, playgrounds, informal activities, and free play.

Increasing physical activity in postpartum multiethnic women in Hawaii: results from a pilot study.

BACKGROUND: Mothers of an infant are much less likely to exercise regularly compared to other women. This study tested the efficacy of a brief tailored intervention to increase physical activity (PA) in women 3-12 months after childbirth. The study used a pretest-posttest design. Sedentary women (n = 20) were recruited from a parenting organization. Half the participants were ethnic minorities, mean age was 33 +/- 3.8, infants' mean age was 6.9 +/- 2.4 months, 50% were primiparas, and mean body mass index was 23.6 +/- 4.2. METHODS: The two-month intervention included telephone counseling, pedometers, referral to community PA resources, social support, email advice on PA/pedometer goals, and newsletters.The primary outcome of the study was minutes per week of moderate and vigorous leisure-time physical activity measured by the Godin physical activity instrument. RESULTS: All women (100%) returned for post-test measures; thus, paired t-tests were used for pre-post increase in minutes of moderate and vigorous leisure-time physical activity and comparisons of moderate and vigorous leisure-time physical activity increases among ethnic groups. At baseline participants' reported a mean of 3 +/- 13.4 minutes per week moderate and vigorous leisure-time physical activity. At post-test this significantly increased to 85.5 +/- 76.4 minutes per week of moderate and vigorous leisure-time physical activity (p < .001, Cohen's d = 2.2; effect size r = 0.7). There were no differences in pre to post increases in minutes of moderate and vigorous leisure-time physical activity among races. CONCLUSION: A telephone/email intervention tailored to meet the needs of postpartum women was effective in increasing physical activity levels. However, randomized trials comparing tailored telephone and email interventions to standard care and including long-term follow-up to determine maintenance of physical activity are warranted.

Park-based physical activity in diverse communities of two U.S. cities. An observational study.

BACKGROUND: Systematic study of human behavior in public parks and specific activity settings can inform policy to promote physical activity in diverse communities. METHODS: Direct observation was used to assess physical activity in public parks in Tampa FL (n=10) and Chicago IL (n=18). Parks were selected from census tracts with high concentrations of white, African-American, and Hispanic populations. Representation from low- and high-income census tracts was also achieved. Physical activity was measured by a modified version of the System for Observing Play and Leisure Activity in Youth (SOPLAY). Activity codes from SOPLAY were transformed to energy expenditure per person (kcal/kg/min). RESULTS: Seventy percent of Tampa and 51% of Chicago park users were observed engaged in sedentary behavior. In both cities, children were more likely than adults to be observed in walking or vigorous activity. In Tampa, parks located in neighborhoods with the highest concentration of Hispanic residents were associated with greatest levels of energy expenditure. In Chicago, parks in neighborhoods with the highest concentration of African Americans showed the highest energy expenditure per person. Gender was associated with physical activity only in Tampa parks. Energy expenditure also varied by activity areas. CONCLUSIONS: More than one half of park users in both cities engaged in sedentary behavior. While differences in park-based physical activity by neighborhood income and racial/ethnic composition were observed, these differences can more likely be attributed to the types of designated activity areas that support physical activity. The study findings suggest that specific configurations of park environments can enhance physical activity in parks.

Multiple health risk behaviors in German first year university students.

Multiple health risk behaviors have been identified as a problem in young adults which includes university students. The goals of this study included assessing the prevalence of major health risk behaviors in a cohort of German first year university students, analyzing the clustering of these behaviors and assessing readiness to change across multiple behaviors. A total of 1262 students from the schools of law, teaching and medicine at a German university participated in a voluntary and anonymous survey in 2005. The study assessed indicators and readiness for change regarding fruit and vegetable consumption, exercise, smoking and binge drinking as well as sociodemographic variables. Confirming the hypotheses, prevalences for risk behaviors were high; over 95% ate less than five servings of fruits and vegetables, 60% did not exercise sufficiently, 31% were current smokers and 62% reported binge drinking. Only 2% had none, 10.5% had one, 34.5% had two, 34.8% had three, and 18.2% showed all four risk behaviors. Readiness for behavior change was very low across multiple risk behavior combinations, especially for reducing binge drinking and increasing fruit and vegetable consumption. Medical students showed slightly more positive patterns than other students. The results indicate the need for addressing health behaviors in the student population of this university. If these findings can be replicated in other universities, programs that promote individual behavior change as well as changes in environmental conditions in the university environment are necessary to address this urgent problem.

Binge drinking and health behavior in medical students.

OBJECTIVES: The objective of this study was to assess the prevalence of binge drinking and its relation to other health behaviors, drinking-related attitudes and perceived social norms among German medical students. METHODS: 271 first-year German medical students completed a cross-sectional, self-administered survey. A total of 252 (62% female and 38% male) students provided useable surveys. The mean age was 20.6years (S.D.=1.7). RESULTS: Most students reported heavy drinking with 24% having one episode in the past 2 weeks (Infrequent Bingers) and 28% having two or more episodes (Frequent Bingers). Men were more likely than women to have had a binge drinking episode. Frequent binge drinkers saw more pros of drinking and reported a higher temptation to drink than students in the other groups. Additionally, they were more likely to smoke, use cannabis, not exercise and not eat fruits and vegetables. All students overestimated their peers' alcohol intake and binge drinking frequency. CONCLUSIONS: Binge drinking was highly prevalent in this sample and clearly related to other health risk behaviors. Drinking rates were similar to college students in other Western countries. Future research needs to assess the consequences of this multiple risk behavior among medical students regarding academic and professional performance as well as personal health.

Validity of beachgoers' self-report of their sun habits.

OBJECTIVE: To examine the validity of beachgoers' self-reported sun protection and UV exposure using objective measures. DESIGN: Eighty-eight participants completed a brief survey when they arrived at the beach; their skin was swabbed for the presence of sunscreen, while an observer recorded their clothing worn to the beach and the presence of sunburn. On leaving the beach, an exit survey detailing activities and sun habits while on the beach was completed by the participants, follow-up sunscreen swabs were obtained, and sunburns were recorded. Clothing observations were made for a subgroup (n = 25) of participants during their beach stay. RESULTS: Most participants (38 [44%]) reported spending 2 to 3 hours at the beach, which was consistent with researcher observations (Spearman rank correlation, r = 0.75). Moderate to substantial agreement was achieved between reported use of sunscreen for the day and sunscreen swabs (kappa, 0.54, 0.70, and 0.72 for the face, legs, and arms, respectively). Participants' self-report of clothing worn to the beach had substantial agreement with researcher observation: kappa coefficients ranged from 0.63 for footwear to 0.77 for head wear. Agreement was variable for clothing worn while on the beach, with slight to fair agreement for sunglasses (kappa, 0.11) and footwear (kappa, 0.23) and substantial agreement for upper body clothing (kappa, 0.79). Agreement between self-reported and observed sunburn was consistently lower (kappa, 0.21, 0.33, and 0.39 for the face, legs, and arms, respectively), with participants reporting more sunburn on arrival than was observed. CONCLUSIONS: Overall, self-report measures of time outside, sunscreen use, and clothing worn demonstrated good criterion validity when compared with observation and sunscreen swabbing. Sunscreen swabbing proved an effective procedure for detecting sunscreen at a beach setting.

Rethinking positive and negative aspects of alcohol use: suggestions from a comparison of alcohol expectancies and decisional balance.

OBJECTIVE: Few studies have compared similar alcohol-related constructs such as alcohol expectancies and decisional balance: two conceptualizations of the positive and negative aspects of alcohol. The purpose of this study was to compare these constructs and to examine their ability to predict alcohol use and problems. METHOD: A sample of 406 college students recruited from Psychology courses at a mid-sized Northeastern University completed a questionnaire that included measures of alcohol expectancies, decisional balance, drinking indices and drinking problems. Of these students, N = 389 (73% female) were drinkers and were included in analyses. RESULTS: Positive expectancies (PE) and the pros were more related to one another than were negative expectancies (NE) and the cons. The 8-item pros scale outperformed 20 items measuring PE in the prediction of alcohol problems and performed equally well in the prediction of alcohol indices. The negative relationship of cons to alcohol indices, something not found with NE, suggested that the cons scale may include components important to the measurement of negative aspects of alcohol. CONCLUSIONS: Although expectancies, particularly PE, have been a common choice for use by researchers, these data suggest that decisional balance scales may be a better choice because their predictive ability is equal to or better than that of expectancies, and their response burden on participants is lower. Instruments that aim to measure the negative aspects of alcohol use should include severe and distal items to better capture this negative attitudinal domain.

Preventing underage drinking: a "roll of the dice".

This study examines the efficacy of a video entitled "Underage Drinking: A Roll of the Dice," and accompanying discussion guide. The video illustrates the civil and criminal consequences of underage drinking. The video and discussion aimed to: (1) increase awareness about the problem of underage drinking; (2) increase viewers' and participants' knowledge and perceptions of the risks and responsibilities and reduce the perceived acceptability of underage drinking; and (3) encourage discussion between youths and adults about underage drinking. The "Roll of the Dice" was evaluated in 19 school and community groups in Hawaii. Groups were randomly assigned to receive follow-up materials or no follow-up materials. Evaluation involved three surveys: pretest, posttest, and follow-up. Three hundred youths and adults responded to the first two surveys, and 220 people completed a third survey. Youths and adults showed increases in short-term knowledge, perceived risk, and perceived responsibility, and a decrease in perceived acceptability of underage drinking after viewing the video. Significant improvement between the pretest and follow-up was observed, although the changes were not entirely maintained at the time of the posttest. The results showed that legal consequences of underage drinking are not common knowledge, and that a well-designed one-time program can make a difference. This video and discussion session provide an inexpensive way to raise adults' and youths' awareness of the laws and penalties, resulting in effects maintained for at least a month after the program. Additional follow-up materials did not enhance retention of changes in knowledge and attitudes.

Randomized controlled community trial of the efficacy of a multicomponent stage-matched intervention to increase sun protection among beachgoers.

BACKGROUND: Skin cancer is about as common as all other cancers combined and is preventable by sun protection. The most intense sun exposures often occur on the beach, so we chose this setting to test an intervention to affect sun protection behaviors. METHODS: We developed a multicomponent stage-matched intervention for beachgoers and evaluated its efficacy in a randomized trial for influencing stage of change and self-reported behavior. RESULTS: We randomized 2,324 persons ages 16 to 65 on the beach (83% of those approached). The intervention was effective in increasing self-reported sun protective behaviors. Effects were similar across gender and age groups. CONCLUSIONS; The beach is a good site for recruitment and intervention to prevent skin cancer in high-risk populations. Our stage-matched intervention package was effective for increasing sun protective behaviors.