Church-Based Social Support's Impact on African-Americans' Physical Activity and Diet Varies by Support Type and Source.

The objective of this study was to examine sources (friends, family, church members, and pastors) and type (positive or negative) of social support and their association with eating and physical activity behaviors. Study participants consisted of 41 African-American adults (78% female), with an average age of 43.5 years (standard deviation = 15.7). Participants were recruited from churches in southwest, Ohio. Mean comparisons showed family members, and friends had the highest positive and negative social support scores for healthy eating and physical activity. Pastors and church members received the lowest social support scores related to these behaviors. Using a linear regression analysis, social support in the form of physical activity rewards from family members was positively associated with fruit and vegetable consumption after adjusting for gender, age, education level, and church location. Based on these findings, future research should continue examining how different social support sources and types influence physical activity and healthy eating behaviors among African-Americans.

Are collegiate athletes as healthy as we think they are?

The current study compared multiple health-risk behaviors, self-efficacy, and temptation between young adult athletes and nonathletes. Cross-sectional data were collected via a web-based survey. Participants included nonathletes and Division I National Collegiate Athletic Association (NCAA) athletes attending a midwestern university. Multiple health-risk behaviors existed at a high prevalence among participating athletes and nonathletes, with a slightly higher proportion of nonathletes reporting more risk. Twenty-two percent of participating athletes were at risk for excessive screen time, whereas 36% of nonathletes were at risk for the same. A higher proportion of athletes were at risk for inadequate sleep (58%) compared with nonathletes (33%). Ninety-eight percent of nonathletes were at risk for inadequate vegetable intake, whereas 96% of athletes were at risk for the same. Risk for low fruit intake was highest among nonathletes (81%) compared with athletes (77%). Future research targeting collegiate athletes' multiple health behavior is warranted.

Intrinsic and Extrinsic Motives Support Adults' Regular Physical Activity Maintenance.

Motives for physical activity were compared between adults who either successfully or unsuccessfully maintained regular physical activity over the last 10 years. Adults age 28-45 (N=721) completed an online survey, reporting their current physical activity levels and self-determination theory (SDT) motives, as well as their physical activity levels at least 10 years prior. With participants' current and retrospective reports of their physical activity, four sample subgroups were created, including maintainers, improvers, decliners, and sedentary. ANOVA analyses were used to examine differences in motives between physical activity maintenance groups. Those who successfully maintained regular physical activity (maintainers) reported higher intrinsic and extrinsic motives compared to those who were not regularly active ( P <0.05). Interestingly, maintainers reported similar physical activity motives compared to those who reported increased physical activity over time. Among the current sample and consistent with theory, motives for physical activity significantly influenced participants' long-term maintenance of regular physical activity. Future interventions should consider these constructs to promote sustained physical activity.

African American Women and Obesity Through the Prism of Race.

BACKGROUND: There are minimal studies focusing on African American women and obesity, and there are even fewer studies examining obesity through a critical race theoretical framework. African American obesity research has largely focused on individual and community interventions, which have not been sufficient to reverse the obesity epidemic. PURPOSE: The purpose of this study was to examine the relationship between race and body mass index (BMI) for African American women. METHOD: Previously collected data from the National Survey of American Life Self-Administered Questionnaire, 2001-2003 (NSAL-SAQ) was analyzed for this study. The NSAL-SAQ dedicated a section to the exploration of group and personal identity, along with having anthropometric data and health habit questions to be able to conduct analyses for associations between the racial identity dimensions and obesity. RESULTS: Multiple linear regression was used to examine the constructs of racial identity on BMI comparing standardized coefficients (ß) and R2adj values. Results indicated participants ascribing more to the stereotype of "Blacks giving up easily" (ß = 0.527, p = .000) showed an increased BMI. Additionally, the negative stereotype of "Blacks being violent" (ß = 0.663, p = .000) and "Blacks being lazy" (ß = 0.506, p = .001) was associated with an increased BMI. CONCLUSIONS: Based on these finds high negative racial regard is associated with increased weight. This study contributes uniquely to the scientific literature, focusing on the construct of racial identity and obesity in African American women.

Future directions of multiple behavior change research.

Non-communicable diseases (i.e., chronic diseases including cardiovascular disease, cancer, chronic respiratory disease, diabetes and obesity) result in 36 million deaths each year. Individuals' habitual participation in a single health-risk behaviors substantially contribute to morbidity and mortality (e.g., tobacco use, daily fast food intake, etc.); however, more concerning is the impact of typically co-occurring or clustering of multiple health-risk behaviors. This burden can be minimized through successful cessation of health-risk behaviors and adoption of healthy behaviors; namely healthy lifestyle adoption or multiple health behavior change (MHBC). MHBC is a developing field and future research recommendations are provided to advance MHBC research. A valid measure of MHBC (i.e., lifestyle) is warranted to provide the needed basis for MHBC investigations and evaluations. MHBC is thought to occur through shared co-variation of underlying motivating mechanisms, but how these relationships influence behavior remains unclear. A better understanding of the relationship between behaviors and the related motivating mechanisms (and potential cross-relationship of influences) is needed. Future research should also aim to improve lifestyles through understanding how to change multiple health behaviors. Finally, MHBC research should target the development of sustainable interventions which result in lasting effects (e.g., capacity, systems, policy and environmental changes), with dissemination considered during development. Focusing MHBC research in these areas will increase our understanding and maximize the impact on the health of populations.

Access to environmental resources and physical activity levels of adults in Hawaii.

PURPOSE: Examine associations between physical activity (PA) and spatial accessibility to environmental PA resources in Hawaii. METHODS: Metabolic equivalents (METs) of mild, moderate, and strenuous PA were compared for accessibility with environmental PA resources within a population-based sample of Hawaiian adults (n = 381). Multiple linear regression estimated differences in PA levels for residing further from a PA resource or residing in an area with a greater number of resources. RESULTS: No associations were found in the total sample. Analyses within subsamples stratified by ethnicity revealed that greater spatial accessibility to a PA resource was positively associated with strenuous PA among Caucasians (P = .04) but negatively associated with moderate PA among Native Hawaiians (P = .00). CONCLUSION: The lack of association in the total sample may be a consequence of Hawaii's unique environment. Results of stratified sample analyses are unique, providing groundwork for future examinations within parallel environments and among similar ethnic groups.

Food outlet accessibility and fruit and vegetable consumption.

PURPOSE: To examine if spatial access to healthy and unhealthy outlets comprising the local food environment was associated with fruit and vegetable consumption. DESIGN: Cross-sectional. SETTING: Population-based sample residing in Hawaii. Subjects . Three hundred and eighty-four adults (36% Asian-American, 33% non-Hispanic white, 31% other/mixed race). MEASURES: A spatial model of the local food environment was constructed using radial buffers extending from participants' place of residence. Fruit and vegetable intake was estimated using the National Cancer Institute Fruit and Vegetable All-Day Screener. ANALYSIS: Mean intakes of fruits and vegetables were compared for spatial access to total, healthy, and unhealthy food outlets at distances of .5 to 3.5 km. Multiple linear regression was used to estimate differences in fruit and vegetable intake for residing further from a food outlet or for residing in an area with a greater number of food outlets. RESULTS: Residing in an area with a greater density of total or healthy food outlets was associated with a higher mean intake of fruits and vegetables (p < .05) at .5 km. No differences in mean intakes were detected for distances beyond .5 km or for regression models. CONCLUSION: Findings suggest that greater spatial accessibility to food outlets comprising the local food environment in Hawaii may not be meaningfully associated with fruit and vegetable consumption; however, associations were detected for the smallest spatial scale examined, warranting further investigation.

Transtheoretical Model Constructs for Physical Activity Behavior are Invariant across Time among Ethnically Diverse Adults in Hawaii.

OBJECTIVES: Physical activity (PA) research applying the Transtheoretical Model (TTM) to examine group differences and/or change over time requires preliminary evidence of factorial validity and invariance. The current study examined the factorial validity and longitudinal invariance of TTM constructs recently revised for PA. METHOD: Participants from an ethnically diverse sample in Hawaii (N=700) completed questionnaires capturing each TTM construct. RESULTS: Factorial validity was confirmed for each construct using confirmatory factor analysis with full-information maximum likelihood. Longitudinal invariance was evidenced across a shorter (3-month) and longer (6-month) time period via nested model comparisons. CONCLUSIONS: The questionnaires for each validated TTM construct are provided, and can now be generalized across similar subgroups and time points. Further validation of the provided measures is suggested in additional populations and across extended time points.

The decisional balance sheet to promote healthy behavior among ethnically diverse older adults.

OBJECTIVE: The rising health care costs and increasing older adult population in the United States make preventive medicine for this age group especially crucial. Regular physical activity and fruit and vegetable consumption may prevent or delay the onset of many chronic conditions that are common among older adults. The decisional balance sheet is a promotional tool targeting the perceived pros and cons of behavior adoption. The current study tested the efficiency and effectiveness of a single-day decisional balance sheet program, targeting increased physical activity and fruit and vegetable intake among older adults. DESIGN AND SAMPLE: Participating adults (N = 21, age = 72.2) who represented a diverse population in Hawaii (Japanese = 5, Filipino = 4, Caucasian = 4, Native American = 1, Native Hawaiian = 1, Hispanic = 1, and Others = 5) were recruited from housing communities and randomized to a decisional balance sheet program adapted for physical activity or fruit and vegetable consumption. MEASURES: Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and daily fruit and vegetable intake with the National Health and Nutrition Examination Survey single item instrument. Baseline and follow-up data were collected. RESULTS: Both programs were implemented efficiently, and participants in both groups improved their daily physical activity. The decisional balance sheet for fruit and vegetable consumption appeared less effective. CONCLUSIONS: Specific suggestions for similar programs are reported.

Successful dissemination of Fun 5 - a physical activity and nutrition program for children.

Examine the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) of an evidence-based physical activity and nutrition curriculum disseminated to after-school programs. Program components included nutrition, physical activity, and sustainability, adapted to after-school settings and disseminated across 4 years (2004-2008). The RE-AIM framework was used to evaluate dissemination quality through direct observations, surveys, and interviews. In the final year, the Fun 5 program was implemented in 90% (>22,000 students) of Hawai'i after-school sites. Despite substantial annual increases in program reach, implementation and adoption remained consistently effective, and students' physical activity levels during program activities peaked in the final year. Further, evaluations demonstrated strong long-term program sustainability potential. The Fun 5 program demonstrated promise for long-term maintenance with potential for a public health impact among Hawai`i after-school students. Future emphasis on wide-spread program dissemination is encouraged, bridging research and community efforts to improve our children's health and impact public health.

Psychometric properties and construct validity of the Weight-Related Eating Questionnaire in a diverse population.

This study evaluates the 16-item, four-factor Weight-Related Eating Questionnaire (WREQ), which assesses theory-based aspects of eating behavior, across diverse, nonclinical subgroups. A total of 621 men and women aged 18-81 years (34.3 ± 16.4) with a mean BMI of 25.7 ± 6.1 kg/m(2) (range 15.5-74.1 kg/m(2)) were recruited from general education classes at the University of Hawai'i, Manoa and an online survey panel of Hawai'i residents to complete a web-based survey. Participants were predominantly white (23%), Asian/Asian-mix (42%), or Native Hawaiian/Pacific Islander (18%). The WREQ's factor structure was successfully replicated by confirmatory factor analysis (CFA) for the entire sample and by weight status, gender, age, and race with strong internal consistency. Four-week test-retest reliability (n = 31) for the subscales was excellent with interclass correlations of 0.849-0.932. Tests of population invariance confirmed the generalizability of the WREQ across all subgroups having provided no evidence that the factor structure, factor loadings, or indicator intercepts varied significantly between the groups. Multivariate regression analyses showed that emotional eating was independently associated with BMI (ß = 0.272, P < 0.001) as well as moderate- and long-term weight change rates (weight gain) in young adults (ß = 0.152, P = 0.042) and adults (ß = 0.217, P = 0.001). Compensatory restraint was negatively associated with weight gain in adults (ß = -0.133, P = 0.039). Routine restraint and emotional eating were highest among dieters. All associations remained significant after accounting for gender, age, and race. The hypothesized WREQ measurement model demonstrated very good construct validity, confirming the unbiased generalizability of the WREQ measure across sex, age, race, and BMI subgroups, and excellent criterion-related validity with respect to current BMI, weight change, and weight control status.

The preventable proportion of type 2 diabetes by ethnicity: the multiethnic cohort.

PURPOSE: To estimate the population-attributable risk (PAR) associated with modifiable risk factors for diabetes among Caucasians, Native Hawaiians, and Japanese Americans in the Hawaii component of the Multiethnic Cohort. METHODS: This analysis is based on 74,970 cohort participants ages 45-75 years who completed a questionnaire on demographics, diet, and lifestyle factors in 1993-1996. After a mean follow-up time of 12.1 (0.01-14.4) years, 8,559 diabetes cases were identified by self-report, a medication questionnaire, and through health plan linkages. Hazard ratios for diabetes and partial PARs for single and different combinations of modifiable risk factors were estimated. RESULTS: Overweight, physical inactivity, high meat intake, no alcohol consumption, and smoking were positively associated with diabetes risk in all ethnic groups. The estimated PARs suggested that among men, 78%, and among women, 83%, of new diabetes cases could have been avoided if all individuals had been in the low risk category for all of the modifiable risk factors. The slightly lower PARs in Japanese Americans were not significantly different from those in Caucasian and Native Hawaiian subjects. CONCLUSIONS: Although PARs varied slightly over ethnicity, our findings do not support ethnic-specific prevention strategies; interventions targeted at multiple behaviors are needed in all ethnic groups.

A Research Agenda to Examine the Efficacy and Relevance of the Transtheoretical Model for Physical Activity Behavior.

Regular physical activity (PA) decreases the risk of several chronic diseases including some cancers, type II diabetes, obesity, and cardiovascular disease; however, the majority of US adults are not meeting the recommended levels to experience these benefits. To address this public health concern, the underlying mechanisms for behavior change need to be understood, translated and disseminated into appropriately tailored interventions. The Transtheoretical Model (TTM) provides a framework for both the conceptualization and measurement of behavior change, as well as facilitating promotion strategies that are individualized and easily adapted. The purpose of this manuscript is to present the constructs of the TTM as they relate to PA behavior change. We begin with a brief synopsis of recent examinations of the TTM constructs and their application. Subsequent to its introduction, we specifically present the TTM within the PA context and discuss its application and usefulness to researchers and practitioners. Criticisms of the TTM are also noted and presented as opportunities for future research to enhance the valid application of the TTM. We offer general study design recommendations to appropriately test the hypothesized relationships within the model. With further examinations using appropriate study design and statistical analyses, we believe the TTM has the potential to advance the public health impact of future PA promotion interventions.

HOP'N after-school project: an obesity prevention randomized controlled trial.

BACKGROUND: This paper reports the primary outcomes of the Healthy Opportunities for Physical Activity and Nutrition (HOP'N) after-school project, which was an effectiveness trial designed to evaluate the prevention of childhood obesity through building the capacity of after-school staff to increase physical activity (PA) and fruit and vegetable (FV) opportunities. METHODS: We conducted a three-year, nested cross-sectional group randomized controlled effectiveness trial. After a baseline assessment year (2005-2006), schools and their after-school programs were randomized to the HOP'N after-school program (n = 4) or control (n = 3), and assessed for two subsequent years (intervention year 1, 2006-2007; intervention year 2, 2007-2008). Across the three years, 715 fourth grade students, and 246 third and fourth grade after-school program participants were included in the study. HOP'N included community government human service agency (Cooperative Extension) led community development efforts, a three-time yearly training of after-school staff, daily PA for 30 minutes following CATCH guidelines, a daily healthful snack, and a weekly nutrition and PA curriculum (HOP'N Club). Child outcomes included change in age- and gender-specific body mass index z-scores (BMIz) across the school year and PA during after-school time measured by accelerometers. The success of HOP'N in changing after-school program opportunities was evaluated by observations over the school year of after-school program physical activity sessions and snack FV offerings. Data were analyzed in 2009. RESULTS: The intervention had no impact on changes in BMIz. Overweight/obese children attending HOP'N after-school programs performed 5.92 minutes more moderate-to-vigorous PA per day after intervention, which eliminated a baseline year deficit of 9.65 minutes per day (p < 0.05) compared to control site overweight/obese children. Active recreation program time at HOP'N sites was 23.40 minutes (intervention year 1, p = 0.01) and 14.20 minutes (intervention year 2, p = 0.10) greater than control sites. HOP'N sites and control sites did not differ in the number of FV offered as snacks. CONCLUSIONS: The HOP'N program had a positive impact on overweight/obese children's PA and after-school active recreation time. TRIAL REGISTRATION: NCT01015599.

Youth proxy efficacy for fruit and vegetable availability varies by gender and socio-economic status.

OBJECTIVE: The current study examined proxy efficacy, which was defined as youth's confidence to influence their parents to provide fruits and vegetables. The overall objective was to examine change in middle-school youth's proxy efficacy over time, and to determine if changes were moderated by gender and socio-economic status. DESIGN: Longitudinal cohort nested within schools. SETTING: Eight middle schools located in urban, suburban and rural areas of a mid-western US state. SUBJECTS: Seven hundred and twelve youth followed across their 6th, 7th and 8th grade years. The sample was 51.8 % female, 30.5 % low socio-economic status and 89.5 % Caucasian, non-Hispanic. RESULTS: Males and lower socio-economic status youth were significantly lower in proxy efficacy at each assessment year compared with females and high socio-economic youth, respectively. CONCLUSIONS: Proxy efficacy to influence parents to provide fruits and vegetables may be an important construct to target in future interventions.

Examining elementary school--aged children's self-efficacy and proxy efficacy for fruit and vegetable consumption.

Children's self-efficacy for fruit and vegetable consumption (FVC) and proxy efficacy to influence others to make fruit and vegetables (FV) available may influence their FVC. A previous investigation has demonstrated that self-efficacy for fruit consumption, self-efficacy for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available can be measured with four independent but related scales. The purpose of the present investigation is to confirm this factor structure and determine if the scales were invariant across gender, ethnicity, and socioeconomic status (SES) subgroups of children attending after-school programs. Results provide further validity evidence for the four correlated scales. In addition, results confirm measurement invariance across gender, SES, and ethnicity, confirming the unbiased generalizability of the current measure to these demographic groups. Lastly, tests of population heterogeneity reveal no meaningful differences in self- and proxy efficacy among gender, SES, and ethnicity subgroups.

Measuring children's self-efficacy and proxy efficacy related to fruit and vegetable consumption.

BACKGROUND: Social cognitive theory describes self-efficacy and proxy efficacy as influences on fruit and vegetable consumption (FVC). Proxy efficacy was defined as a child's confidence in his or her skills and abilities to get others to act in one's interests to provide fruit and vegetable (FV) opportunities. The purpose of this study was to develop a scale assessing children's self-efficacy and proxy efficacy for FVC at after-school programs and at home. METHODS: Elementary-aged children (n = 184) attending 7 after-school programs completed a self-efficacy questionnaire relevant to FVC. Questionnaire validity was investigated with exploratory factor analysis and mixed-model analysis of covariance. Internal consistency reliability and readability were also assessed. RESULTS: The questionnaire assessed 4 constructs: self-efficacy expectations for fruit consumption, self-efficacy expectations for vegetable consumption, proxy efficacy to influence parents to make FV available, and proxy efficacy to influence after-school staff to make FV available. Children perceiving FV opportunities in after-school had greater self-efficacy expectations for FVC and greater proxy efficacy to influence after-school staff compared to students who did not perceive FV opportunities. Children attending schools of higher socioeconomic status (SES) and less diversity were more confident they could influence their parents to make FV available than students attending lower SES and less diverse schools. Adequate internal consistency and test-retest reliabilities were established. CONCLUSIONS: Self-efficacy is a multicomponent construct that can be assessed in children using the reliable and valid instrument evaluated by the current study.

Longitudinal and cross-sectional influences on youth fruit and vegetable consumption.

Both cross-sectional and longitudinal research depict a decline in the fruit and vegetable consumption (FVC) of children and youths with age, but identifying developmental changes and their influences with regard to FVC cannot be fully explained with application of only one of these research designs. Reviewed here are results from longitudinal and cross-sectional research, and a proposal is presented for a lifespan development methodology that uses a sequential design strategy to illuminate the multilevel processes that determine FVC. Conclusions from the review were similar for both cross-sectional and longitudinal research, with fruit and vegetable (FV) preferences and FV accessibility/availability being the most consistent influences on FVC. Furthermore, this review illuminates several methodological issues, offering suggestions to strengthen comparisons between studies. Research designs that incorporate longitudinal, cross-sectional, and time-lag data are warranted.

Physical activity and healthy eating in the after-school environment.

BACKGROUND: No research to date has extensively described moderate and vigorous physical activity (MVPA) and healthful eating (HE) opportunities in the after-school environment. The current study described the quality of the after-school environment for its impact on children's MVPA and HE. METHODS: An alliance of 7 elementary schools and Boys and Girls Clubs who worked with the Cooperative Extension Service in Lawrence, KS, was selected to participate in a larger intervention study. After-school settings were observed for information regarding session type, session context, leader behavior, physical activity, and snack quality using validated instruments such as the System for Observing Fitness Instruction Time. Data presented are baseline measures for all sites. RESULTS: Participating children (n = 144) were primarily non-Hispanic white (60%) and in fourth grade (69%). After-school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in MVPA during free play sessions (69%) compared to organized adult-led sessions (51%). There was also significantly more discouragement of physical activity during organized adult-led sessions (29%) as compared to the free play sessions (6%). CONCLUSIONS: The quality of after-school programs can be improved by providing fruits and vegetables as snacks; offering more free play activities; training the after-school staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model MVPA and HE in and out of the after-school setting.