Cardiorespiratory fitness, adiposity, and ambulatory blood pressure in adolescents.

BACKGROUND: This study examined the association of cardiorespiratory fitness (fitness) and adiposity (Body Mass Index [BMI] and waist circumference [WC]) with ambulatory blood pressure (ABP) and tested the moderating effect of adiposity on the association between fitness and ABP. METHODS: A cross-sectional study was conducted with 370 adolescents aged 11-16 years. Fitness was assessed by a height-adjusted step test and estimated by heart rate recovery, defined as the difference between peak heart rate during exercise and heart rate two minutes postexercise. Adiposity was measured using dichotomized values for percentiles of BMI (≥85th) and WC (≥50th). ABP was measured every 30-60 minutes over 24 hours on a school day. Mixed-effects regression analysis was used. RESULTS: Each unit increase in fitness was associated with a decrease of systolic blood pressure (SBP) [-0.058 mmHg, P=0.001] and diastolic blood pressure (DBP) [-0.043 mmHg, P<0.001] after adjustment for WC and covariates. Each unit increase in fitness was associated with a decrease in SBP [-0.058 mmHg, P=0.001] and DBP [-0.045 mmHg, P<0.001] after adjustment for BMI and covariates. Fitness and BMI≥85th percentile (or WC ≥ 50th percentile) interactions were not associated with ABP after adjustment for covariates. CONCLUSIONS: Our findings indicate a small but statistically significant inverse effect of fitness on ABP in adolescents. No evidence of a modifying effect of adiposity on this association suggesting that fitness and weight management have essential roles for maintaining lower ABP in adolescents.

Individual and community characteristics associated with premature natural and drug-related deaths in 25-59 year old decedents.

The purpose of the study was to identify circumstances of death, disease states, and sociodemographic characteristics associated with premature natural and drug-related deaths among 25-59 year olds. The study also aimed to address the paucity of research on personal, community-based, and societal factors contributing to premature death. A population-based retrospective chart review of medical examiner deaths within a highly populated and ethnically diverse county [in Texas] was undertaken to identify individuals dying prematurely and circumstances surrounding cause of death [in 2013]. The sample data (n = 1282) allowed for analysis of decedent demographic variables as well as community characteristics. Descriptive statistics, multivariable logistic regression, and geospatial analyses were used to test for associations between the type of death (natural or drug-related) and demographics, circumstances of death, disease types and community characteristics. Census tract data were used to determine community characteristics. Highly clustered premature deaths were concentrated in areas with low income and under-educated population characteristics. Two-thirds of decedents whose death were due to disease had not seen a healthcare provider 30 days before death despite recent illness manifestations. Opioids were found in 187 (50.5%) of the drug-related deaths, with 92.5% of deaths by opioids occurring in combination with other substances. The study findings went beyond the cause of death to identify circumstances surrounding death, which present a more comprehensive picture of the decedent disease states and external circumstances. In turn, these findings may influence the initiation of interventions for medically underserved and impoverished communities.

Ethnic/Racial Comparisons in Strategies Parents Use to Cope with Food Insecurity: A Systematic Review of Published Research.

Food insecurity in US affects African Americans, Hispanic, and American Indians disproportionately compared to Caucasians. Ethnicity/race may influence the strategies parents use to reduce the effects of food insecurity. The purpose of this review is to compare coping strategies for food insecurity used by parents of different ethnicities/race as reported in published literature. A systematic search on PubMed and Embase yielded 983 studies, of which 13 studies met inclusion criteria and were reviewed. All groups used public and private assistance, social networks, nutrition related, and financial-related strategies. The limited evidence suggests that there are differences in how parents of different ethnicities/race apply these coping strategies. Current evidence is insufficient to confidently determine the extent of these differences. This review is a starting point for exploration of cultural differences in how parents of various ethnicities/race cope with food insecurity and identifies specific areas for further research.

Clinical and demographic predictors of concussion resolution in adolescents: A retrospective study.

Concussions in adolescents are a growing public health concern. The aim of this study was to identify clinical (e.g., concussion history, migraine history, learning disabilities/ADHD) and demographic factors (e.g., age, sex, race, health insurance status, mechanism of injury, education) that predict concussion recovery times. In a retrospective cohort study of 118 adolescents 13-19 years old who were evaluated for an acute concussion (≤10 days from injury), recovery times were calculated from the date of concussive injury to the date of clearance to return to play and/or normal activities. The median time to recovery was 17 days. Predictors of longer recovery included ADHD (HR = .221, 95% CI = .095 - .514, p < .001) and prior concussion (HR = .564, 95% CI = .332 - .959, p = .03). Student athletic insurance and public insurance were predictors of shorter recovery times (HR = 3.98, 95% CI = 1.25 - 12.65, p = .02 and HR = 3.33, 95% CI = 1.09 - 10.15, p = .03, respectively). In adolescents with prior concussion or ADHD, clearance to return to play/ normal activities may be delayed. Further research is needed to validate the impact of SES/health insurance on concussion recovery time.

Exenatide once weekly for smoking cessation: study protocol for a randomized clinical trial.

BACKGROUND: Cigarette smoking is the greatest preventable cause of morbidity and premature mortality in the United States. Approved pharmacological treatments for smoking cessation are marginally effective, underscoring the need for improved pharmacotherapies. A novel approach might use glucagon-like peptide-1 (GLP-1) agonists, which reduce alcohol and drug use in preclinical studies. GLP-1 is produced in the intestinal L-cells and in the hindbrain. The peptide maintains glucose homeostasis and reduces food intake. Several GLP-1 agonists are used clinically to treat type 2 diabetes and obesity, but none have been tested in humans to reduce smoking. AIMS: We will examine whether extended-release exenatide reduces smoking, craving, and withdrawal symptoms, as well as cue-induced craving for cigarettes. METHODS: We will enroll prediabetic and/or overweight treatment seeking smokers (n = 90) into a double-blind, placebo-controlled, randomized clinical trial. Participants will be randomized in a 1:1 ratio to receive exenatide or placebo. All participants will receive transdermal nicotine replacement therapy (NRT) and behavioral counseling. Abstinence from smoking (verified via expired CO level of ≤5 ppm), craving (Questionnaire of Smoking Urges score), and withdrawal symptoms (Wisconsin Scale of Withdrawal Symptoms score) will be assessed weekly during 6 weeks of treatment and at 1 and 4 weeks posttreatment. Cue-induced craving for cigarettes will be assessed at baseline and at 3 weeks of treatment following virtual reality exposure. EXPECTED OUTCOMES: We hypothesize that exenatide will increase the number of participants able to achieve complete smoking abstinence above that achieved via standard NRT and that exenatide will reduce craving and withdrawal symptoms, as well as cue-induced craving for cigarettes.

Effects of Cognitive Behavior Therapy on Heart Rate Variability in Young Females with Constipation-predominant Irritable Bowel Syndrome: A Parallel-group Trial.

BACKGROUND/AIMS: The relation between heart rate variability (HRV) as non-invasive biomarkers of autonomic function and cognitive behavior therapy (CBT) as non-pharmacological treatments has rarely been examined in patients with constipation-predominant irritable bowel syndrome (IBS-C). The purpose of this study is to evaluate the efficacy of an 8-week CBT intervention on HRV and IBS symptoms, and the correlation of changes in HRV with changes in IBS symptoms among young female nursing students with IBS-C. METHODS: This study consisted of an exploratory subgroup analysis of 43 participants with IBS-C who had been randomly assigned to receive either 8 weeks of CBT (n = 23) or general medical information (control, n = 20). At baseline and 8, 16, and 24 weeks, participants completed a questionnaire assessing their gastrointestinal (GI) symptoms, anxiety, depression, and stress, and their HRV was measured via electrocardiography. RESULTS: At the 8-week follow-up, the high-frequency (HF) power was significantly higher, and the low-frequency (LF)/HF ratio was lower in the CBT group than in the control group (P < 0.001 for both), and the severity of GI symptoms (P = 0.003), anxiety (P < 0.001), depression (P < 0.001), and stress (P < 0.001) was significantly lower in the CBT group than in the control group. Changes in the HF power were significantly and inversely associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from -0.37 to -0.68). Changes in the LF/HF ratio were also significantly and positively associated with changes in GI symptoms, anxiety, depression, and stress at 16 and 24 weeks (P < 0.05 for all; range of r from 0.38 to 0.60). CONCLUSIONS: CBT was effective in managing symptoms in young IBS-C patients and the improvement of symptoms was sustained at 24 weeks following the completion of CBT. Furthermore, indirect measurement of autonomic function using HRV may be a useful objective parameter for assessing response to CBT in young IBS-C patients.

The Reliability and Validity of the Arabic World Health Organization Quality of Life-BREF Instrument Among Family Caregivers of Relatives With Psychiatric Illnesses in Jordan.

BACKGROUND: The concept of quality of life (QOL) has increasingly attracted the interest of healthcare providers and is considered a valid end point for assessing the overall mental health of patients and their caregivers. Instruments with psychometric and cross-cultural validity are recommended for making accurate QOL assessments. PURPOSE: The aim of this study was to provide further validation of the Arabic World Health Organization (WHO)QOL-BREF for use among family caregivers of relatives with psychiatric illnesses in Jordan. Of the 26 items that constitute the scale, 24 are in the domains of physical health, psychological health, social interactions, and environment. METHOD: Of the 328 family caregivers approached, data for 266 respondents were kept for analysis. The Arabic WHOQOL-BREF internal consistency, item internal consistency, item discriminant validity, and construct validity were evaluated. RESULTS: The Cronbach's alpha coefficient was ≥0.7. The 24 items constituting the evaluated domains reported an item internal consistency of ≥0.4 and met the item discriminant validity criterion of having a higher correlation with its corresponding domain than with other domains. Factor analysis revealed four strong factors that constituted the same constructs as in the WHO report. CONCLUSIONS: This study ascertains further validity of the Arabic WHOQOL-BREF scale for use among family caregivers of relatives with psychiatric illnesses in Jordan.

Association of cardiorespiratory fitness and adiposity with inflammatory biomarkers in young adults.

OBJECTIVES: Cardiorespiratory fitness (fitness) has been inversely associated with inflammation, but whether the association is attributed to fitness itself or lower levels of adiposity remains uncertain in young adults. The purpose of this study was to determine the association of fitness and adiposity with inflammation in young adults. METHODS: A cross-sectional study was conducted with 88 participants aged 20-34 years. Fitness was assessed by a submaximal treadmill walking test. Adiposity was assessed by body mass index (BMI) and waist circumference (WC). Inflammation was measured by plasma C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) levels using immunoassays. Biological data were log10 transformed. A separate multiple regression analysis was conducted with each inflammatory biomarker as a dependent variable. Covariates (sex, oral contraceptive use, and education level) were adjusted. RESULTS: Fitness was inversely associated with log10 CRP after adjustment for covariates but not after adjusting for BMI or WC. Fitness was inversely associated with log10 IL-6 after adjustment for WC and covariates (ß = -0.341, P = .049) but not after adjusting for BMI. Fitness × WC interaction (partial eta2 = 0.056, P = .033) indicated that high fitness was more strongly associated with low log10 IL-6 in young adults with high WC than those with low WC. CONCLUSIONS: Although adiposity has a stronger association than fitness with CRP and IL-6, higher levels of fitness could be essential for maintaining low levels of IL-6, especially in the presence of high levels of central adiposity.

Methodology to reliably measure preventable trauma death rate.

This article describes a methodology to establish a trauma preventable death rate (PDR) in a densely populated county in the USA. Harris County has >4 million residents, encompasses a geographic area of 1777 square miles and includes the City of Houston, Texas. Although attempts have been made to address a national PDR, these studies had significant methodological flaws. There is no national consensus among varying groups of clinicians for defining preventability or documenting methods by which preventability is determined. Furthermore, although trauma centers routinely evaluate deaths within their hospital for preventability, few centers compare across regions, within the prehospital arena and even fewer have evaluated trauma deaths at non-trauma centers. Comprehensive population-based data on all trauma deaths within a defined region would provide a framework for effective prevention and intervention efforts at the regional and national levels. The authors adapted a military method recently used in Southwest Asia to determine the potential preventability of civilian trauma deaths occurring across a large and diverse population. The project design will allow a data-driven approach to improve services across the entire spectrum of trauma care, from prevention through rehabilitation.

Anesthetic choices and breast cancer recurrence: a retrospective pilot study of patient, disease, and treatment factors.

The purpose of this work was to investigate differences in patient, disease, and treatment factors between women who received outpatient surgical treatment of breast cancer with paravertebral and general anesthesia compared with women who received general anesthesia alone. A total of 358 patients with stage 0-III disease received a partial or total mastectomy without axillary node dissection at a large academic cancer center. Study median follow-up time was 28.8 months. Patient demographic characteristics were equally represented across anesthesia groups. Mean body mass index (kg/m) was greater in those who received general anesthesia alone (mean = 29, SD = 6.8) than in those who received paravertebral regional block with general anesthesia (mean = 28, SD = 5.1) (P = .001). The paravertebral regional block with general anesthesia group contained advanced stages of disease (P = .01) and had longer surgical procedures (P = .01) than the general anesthesia alone group. Breast cancer recurrence was detected in 1.7% of the study population (paravertebral regional block with general anesthesia: n = 4; and general anesthesia alone: n = 2). Overall, no association between anesthesia type and recurrence was detected (P = .53), with an unadjusted estimated hazard ratio of 1.84 (95% confidence interval, 0.34-10.08). The overall rate of recurrence was very small in this population. A larger study is needed to detect significant differences in rates of recurrence attributable to type of anesthesia.

Features of the built environment related to physical activity friendliness and children's obesity and other risk factors.

OBJECTIVES: We investigated the relationships among environmental features of physical activity friendliness, socioeconomic indicators, and prevalence of obesity (BMI status), central adiposity (waist circumference, waist-height ratio), and hypertension. DESIGN AND SAMPLE: The design was cross-sectional; the study was correlational. The sample was 911 kindergarteners through sixth graders from three schools in an urban school district residing in 13 designated neighborhoods. MEASURES: Data from walking environmental community audits, census data for socioeconomic indicators, body mass index, waist circumference, waist-height ratio, and blood pressure were analyzed. A modified Alfonzo's Hierarchy of Walking Needs model was the conceptual framework for environmental features (i.e., accessibility, safety, comfort, and pleasurability) related to physical activity. RESULTS: Accessibility was significantly and negatively correlated with prevalence of obesity and with prevalence of a waist-height ratio >0.50. When neighborhood education was controlled, and when both neighborhood education and poverty were controlled with partial correlational analysis, comfort features of a walking environment were significantly and positively related to prevalence of obesity. When poverty was controlled with partial correlation, accessibility was significantly and negatively correlated with prevalence of waist-height ratio >0.50. CONCLUSIONS: The built environment merits further research to promote physical activity and stem the obesity epidemic in children. Our approach can be a useful framework for future research.

Severe depressive symptoms are associated with elevated endothelin-1 in younger patients with acute coronary syndrome.

OBJECTIVE: To explore the relationship of depressive symptom severity to circulating endothelin (ET)-1 in younger patients with acute coronary syndrome (ACS). Younger patients report greater depressive symptom severity, which predicts poorer post-ACS prognosis. The pathways linking depression to post-ACS prognosis require further elucidation. ET-1 is a potent endogenous vasoconstrictor which has been previously linked to adverse post-ACS outcomes. METHODS: The sample (n=153) included males ≤ 50 years of age and females ≤ 55 years of age who participated in a larger study. Blood samples for ET-1 assessment were collected within 2-3h of ACS admission. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) II within 2-5 days of admission. ET-1 was treated as a transformed continuous variable (ET-1T). BDI-II scores were classified into four categories using conventional thresholds demarcating mild, moderate, and severe levels of depressive symptoms. The relationship of classified BDI-II score to ET-1T was examined in simple and multivariable linear regression models. RESULTS: Classified BDI-II score was related to ET-1T in both unadjusted (χ(2)=9.469, p=0.024) and multivariable (χ(2)=8.430, p=0.038) models, with ET-1T being significantly higher in patients with severe depressive symptoms than in those with mild and moderate depressive symptoms. CONCLUSIONS: In this sample of younger post-ACS patients, severe depressive symptoms were associated with elevated ET-1. We acknowledge that the observed association could be eliminated by the inclusion of some unmeasured variable(s). Longitudinal research should examine whether ET-1 mediates the relationship of depressive symptoms to long-term post-ACS outcomes.

Sleep duration and its association with ambulatory blood pressure in a school-based, diverse sample of adolescents.

BACKGROUND: Evidence is accumulating that sleep duration is related to blood pressure (BP) and hypertensive status, but the strength of the association varies by age, and findings are inconsistent for adolescents. This cross-sectional study tested the hypothesis that sleep duration, both during the night and during naps, would be negatively associated with ambulatory systolic BP (SBP) and diastolic BP (DBP) measured over 24 hours in adolescents. METHODS: In this ethnically diverse (37% non-Hispanic black, 31% Hispanic, 29% non-Hispanic white, 3% other), school-based sample of 366 adolescents aged 11-16 years, ambulatory BP was measured every 30 minutes for 24 hours on a school day; actigraphy was used to measure sleep duration. Covariables included demographic factors, anthropometric indices, physical activity, and position and location at the time of each BP measurement. Mixed models were used to test day and night sleep duration as predictors of 24-hour SBP and DBP, controlling for covariables. RESULTS: The mean sleep duration was 6.83 (SD = 1.36) hours at night, and 7.23 (SD = 1.67) hours over 24 hours. Controlling for duration of sleep during the day and covariables, each additional hour of nighttime sleep was associated with lower SBP (-0.57; P < 0.0001); controlling for nighttime sleep duration and covariables, each additional hour of daytime sleep was associated with lower SBP (-0.73; P < 0.001) and lower DBP (-0.50; P < 0.001). CONCLUSIONS: Longer sleep duration was significantly associated with lower ambulatory SBP and DBP in adolescents. The findings have potential implications for cardiovascular health in this age group.

Endothelin-1 and psychosocial risk factors for cardiovascular disease: a systematic review.

OBJECTIVES: Psychosocial factors (i.e., social environment and emotional factors) contribute to an increased risk of cardiovascular disease (CVD). Perturbation in a potent vasoconstrictive peptide endothelin (ET)-1 could be one of the mechanisms linking psychosocial factors to CVD. Our aim was to evaluate the literature on the relationship between plasma ET-1 and psychosocial risk factors for CVD. METHODS: MEDLINE and PsycINFO databases were searched for articles on human studies published in peer-reviewed English-language journals through September 2012. RESULTS: Of the 20 studies that met the inclusion criteria, 14 were experimental studies of acute psychological/mental challenges and 6 were observational studies of psychological and social factors. The inferences drawn from this review were as follows: a) laboratory-induced acute psychological/mental stress may result in exaggerated plasma ET-1 release in those with CVD and those at risk for CVD (positive studies: 5/10); b) chronic/episodic psychosocial factors may have a positive relationship to plasma ET-1 (positive studies: 3/5); and c) race (African American), sex (male), and individual differences in autonomic and hemodynamic responses to stress (parasympathetic withdrawal and elevated blood pressure responsiveness) may moderate the relationship between psychosocial factors and plasma ET-1. CONCLUSIONS: This review indicates that psychosocial risk factors for CVD are associated with elevated plasma ET-1; however, the relatively small number of studies, methodological differences, and variable assessment tools preclude definitive conclusions about the strength of the association. Specific suggestions regarding the selection of psychosocial factors, optimization of acute challenge protocols, and standardization of methods and timing of the ET-1 measures are provided.

Sociocultural tailoring of a healthy lifestyle intervention to reduce cardiovascular disease and type 2 diabetes risk among Latinos.

BACKGROUND: Suboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. We describe a community-academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos. COMMUNITY CONTEXT: The community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. This growth underscores the need for socioculturally appropriate health resources. METHODS: Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted. OUTCOMES: Postintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk. Feedback indicated the program was socioculturally acceptable and responsive to community needs. INTERPRETATION: These findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. The project highlights contributions of community-based processes in tailoring interventions that are appropriate for community contexts.

Novel predictors of sepsis outperform the American Burn Association sepsis criteria in the burn intensive care unit patient.

The purpose of this study was to determine whether systemic inflammatory response syndrome (SIRS) and American Burn Association (ABA) criteria predict sepsis in the burn patient and develop a model representing the best combination of novel clinical sepsis predictors. A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010 was made. Blood culture results were paired with documented sepsis: positive-sick, negative-sick (collectively defined as sick), and negative-not sick. Data for all predictors were collected for the 72 hours before blood culture. Variables were evaluated using regression and area under the curve (AUC) analyses. Fifty-nine subjects represented 177 culture periods. SIRS criteria were not discriminative: 98% of the subjects met criteria. ABA sepsis criteria were different on the day before (P = .004). The six best-fit variables identified for the model included heart rate > 130 beats per min, mean arterial pressure < 60 mm Hg, base deficit < -6 mEq/L, temperature < 36°C, use of vasoactive medications, and glucose > 150 mg/dl. The model was significant in predicting positive-sick and sick, with an AUC of 0.775 (P < .001) and 0.714 (P < .001), respectively; comparatively, the ABA criteria AUC was 0.619 (P = .028) and 0.597 (P = .035), respectively. Usefulness of the ABA criteria to predict sepsis is limited to the day before blood culture is obtained. A significant contribution of this research is the identification of six novel sepsis predictors for the burn patient.

Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature.

The purpose of this systematic review of the literature was to determine the association of sepsis with mortality in the severely injured adult patient by means of a comparative analysis of sepsis in burn and trauma injury with other critically ill populations. The MEDLINE (PubMed), Cochrane Library, and ProQuest databases were searched. The following keywords and MeSH headings were used: "sepsis," septicemia," "septic shock," "epidemiology," "burns," "thermal injury," "trauma," "wounds and injuries," "critical care," "intensive care," "outcomes," and "mortality." Included studies were clinical studies of adult burn, trauma, and critically ill patients that reported survival data for sepsis. Thirty-eight articles were reviewed (9 burn, 11 trauma, 18 general critical care). The age of burn (<45 years) and trauma (34-49 years) groups was lower than the general critical care (57-64 years) population. Sepsis prevalence varied with trauma-injured patients experiencing fewer episodes (2.4%-16.9%) contrasted with burn patients (8%-42.5%) and critical care patients (19%-38%). Survival differed with trauma patients experiencing a lower rate of mortality associated with sepsis (7%-36.9%) compared with the burn (28%-65%) and critical care (21%-53%) groups. This study is the first to compare sepsis outcomes in three distinct patient populations: burn, trauma, and general critical care. Trauma patients tend to have relatively low sepsis-associated mortality; burn patients and the older critical care population have higher prevalence of sepsis with worse outcomes. Great variability of criteria to identify septic patients among studies compromises population comparisons.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

A structured, interactive method for youth participation in a school district-university partnership to prevent obesity.

BACKGROUND: The involvement of school-age children in participatory research is described in the context of a school district-university partnership to prevent obesity in children. The purpose of this study was to elicit, from children in kindergarten (K) through sixth grade, perceptions of foods and activities that would inform the design of developmentally appropriate interventions to prevent and reduce childhood obesity. METHODS: Children (N = 218) were selected through a random sample of K through sixth grade classrooms in 3 schools. They participated in structured, interactive, small group exercises focused on perceptions of foods (taste and healthy/unhealthy) and activities (fun and active/sedentary). High school students in the same school district were trained to facilitate the children's groups in collaboration with university faculty and students. RESULTS: Qualitative data analysis was used to discern patterns across grade levels. There were grade-level differences in perceptions of the taste and healthfulness of foods. Younger children (K-1) equated foods that tasted good with foods that were "good for you." Older children were more discriminating and gave reasons for their perceptions. For activities, fun was positively associated with the number of people involved and the amount of movement. There were fewer differences across grade levels in preferences for types of sedentary activities, compared with sports and other activities that "make you move." CONCLUSIONS: The findings have implications for developmentally appropriate health promotion interventions to prevent obesity. These structured but highly interactive methods could be used by school personnel to assess the unique needs of a school population.