Suchergebnisse

Purpose. To examine associations between perceived neighborhood characteristics, access to places for activity, and leisure-time physical activity. Design. Cross-sectional telephone survey. Setting. Cabarrus, Henderson, Pitt, Robeson, Surry, and Wake counties in North Carolina. Subjects. Population-based sample of 1796 adults at least 18 years of age residing in the six counties. Measures. The 133-item questionnaire assessed self-reported leisure-time physical activity and perceptions of neighborhood characteristics (sidewalks, trails, heavy traffic, streetlights, unattended dogs, and safety from crime) and general access to places for physical activity. Results. Trails, streetlights, and access to places were positively associated with engaging in any leisure activity: unadjusted odds ratio (OR) (95% confidence interval [CI]); 1.62 (1.09–2.41), 1.57 (1.14–2.17), and 2.94 (1.91–4.52), respectively. Trails and access to places were positively associated with engaging in the recommended amount of leisure activity: 1.49 (1.00–2.22), and 2.28 (1.30–4.00), respectively). In multivariable logistic regression modeling including environmental factors and demographics, access to places was associated with any activity (2.23 [1.44–3.44]) and recommended activity (2.15 [1.23–3.77]), and trails were associated with recommended activity (1.51 [1.00–2.28]). Conclusion. Certain neighborhood characteristics, particularly trails, and access to places for physical activity may be associated with leisure activity levels. In this study, perceived neighborhood environmental factors and access to places for physical activity were strongly associated with race, education, and income.

Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Analyses: Multinomial logistic regression and post-hoc marginal effects models. Results: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. Conclusion: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.

<p><strong>Objective: </strong>Physical activity (PA) is beneficial for health, yet most African American women do not achieve recommended levels. Successful, sustainable strategies could help to address disparities in health outcomes associated with low levels of PA. The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-based and a secular intervention for increasing PA with a selfguided control group. </p><p><strong>Design Setting Participants: </strong>This cluster randomized, controlled trial was conducted from 2010 – 2011 in African American churches (n=31) in suburban North Carolina. Participants were 469 self-identified low active African American women. </p><p><strong>Measures: </strong>Baseline data were collected on participant demographics, objective and self-reported PA, and constructs related to social ecological theory and social cognitive theory. </p><p><strong>Results: </strong>Complete baseline data were available for 417 participants who were aged 51.4 ± 12.9 years, with average BMI (kg/ m2) 35.8 ± 9.9; 73% of participants were obese (BMI &gt;30). Participants averaged 3,990 ± 1,828 pedometer-assessed daily steps and 23.9 ± 37.7 accelerometer-assessed minutes of daily moderate-to-vigorous PA, and self-reported 25.4 ± 45.4 minutes of weekly walking and moderate- and vigorous-intensity PA. Baseline self-reported religiosity and social support were high. </p><p><strong>Conclusions: </strong>L.A.D.I.E.S. is one of the largest PA trials focused on individual behavior change in African American women. Baseline characteristics suggest participants are representative of the general population. Findings from the study will contribute toward understanding appropriate strategies for increasing PA in high-risk populations.</p><p><em>Ethn Dis. </em>2017;27(3):257-264; doi:10.18865/ed.27.3.257 </p>

<p><strong>Objective: </strong>The Learning and Developing Individual Exercise Skills (L.A.D.I.E.S.) for a Better Life study compared a faith-integrated (FI) and a secular (SEC) intervention for increasing physical activity with a self-guided (SG) control group among African American women. <strong></strong></p><p><strong>Design/Setting/Participants: </strong>L.A.D.I.E.S. was a cluster randomized, controlled trial. Churches (n=31) were randomized and women within each church (n=12 – 15) received the same intervention. <strong></strong></p><p><strong>Interventions: </strong>FI and SEC participants received 24 group-based sessions, delivered over 10 months. SG participants received printed materials to review independently for 10 months. Participants were followed for 12-months post-intervention to assess long-term intervention impact. </p><p><strong>Main Outcome Measures: </strong>Data on participant characteristics, physical activity, and intervention-related constructs were collected at baseline, 10 months, and 22 months. <strong></strong></p><p><strong>Results: </strong>Intervention session attendance was greater for FI compared with SEC participants (15.7 + 5.7 vs 12.4 + 7.3 sessions, respectively, P&lt;.01). After 10 months, FI and SEC participants significantly increased daily walking (+1,451 and +1,107 steps/ day, respectively) compared with SG participants (-128 steps/day). Increases were maintained after 22 months in the FI group compared with the SG group (+1092 vs. +336 daily steps, P&lt;.01). Between-group changes in accelerometer-assessed physical activity were not statistically significant at any time point. <strong></strong></p><p><strong>Conclusions: </strong>The FI intervention is a feasible strategy for short- and long-term increases in physical activity among African American women. Additional dissemination and evaluation of the strategy could be useful for reducing chronic disease in this high-risk population. <em></em></p><p><em>Ethn Dis.</em>2017;27(4):411- 420; doi:10.18865/ed.27.4.411. </p>

BackgroundMost studies on the local food environment have used secondary sources to describe the food environment, such as government food registries or commercial listings (e.g., Reference USA). Most of the studies exploring evidence for validity of secondary retail food data have used on-site verification and have not conducted analysis by data source (e.g., sensitivity of Reference USA) or by food outlet type (e.g., sensitivity of Reference USA for convenience stores). Few studies have explored the food environment in American Indian communities. To advance the science on measuring the food environment, we conducted direct, on-site observations of a wide range of food outlets in multiple American Indian communities, without a list guiding the field observations, and then compared our findings to several types of secondary data.MethodsFood outlets located within seven State Designated Tribal Statistical Areas in North Carolina (NC) were gathered from online Yellow Pages, Reference USA, Dun & Bradstreet, local health departments, and the NC Department of Agriculture and Consumer Services. All TIGER/Line 2009 roads (>1,500 miles) were driven in six of the more rural tribal areas and, for the largest tribe, all roads in two of its cities were driven. Sensitivity, positive predictive value, concordance, and kappa statistics were calculated to compare secondary data sources to primary data.Results699 food outlets were identified during primary data collection. Match rate for primary data and secondary data differed by type of food outlet observed, with the highest match rates found for grocery stores (97%), general merchandise stores (96%), and restaurants (91%). Reference USA exhibited almost perfect sensitivity (0.89). Local health department data had substantial sensitivity (0.66) and was almost perfect when focusing only on restaurants (0.91). Positive predictive value was substantial for Reference USA (0.67) and moderate for local health department data (0.49). Evidence for validity was comparatively lower for Dun & Bradstreet, online Yellow Pages, and the NC Department of Agriculture.ConclusionsSecondary data sources both over- and under-represented the food environment; they were particularly problematic for identifying convenience stores and specialty markets. More attention is needed to improve the validity of existing data sources, especially for rural local food environments.

Purpose:Parents and caregivers play an important role in sexual socialization of youth, often serving as the primary source of information about sex. For African American rural youth who experience disparate rates of HIV/sexually transmitted infection, improving caregiver–youth communication about sexual topics may help to reduce risky behaviors. This study assessed the impact of an intervention to improve sexual topic communication.Design:A Preintervention–postintervention, quasi-experimental, controlled, and community-based trial.Setting:Intervention was in 2 rural North Carolina counties with comparison group in 3 adjacent counties.Subjects:Participants (n = 249) were parents, caregivers, or parental figures for African American youth aged 10 to 14.Intervention:Twelve-session curriculum for participating dyads.Measures:Audio computer-assisted self-interview to assess changes at 9 months from baseline in communication about general and sensitive sex topics and overall communication about sex.Analysis:Multivariable models were used to examine the differences between the changes in mean of scores for intervention and comparison groups.Results:Statistically significant differences in changes in mean scores for communication about general sex topics ( P < .0001), communication about sensitive sex topics ( P < .0001), and overall communication about sex ( P < .0001) existed. Differences in change in mean scores remained significant after adjusting baseline scores and other variables in the multivariate models.Conclusions:In Teach One Reach One intervention, adult participants reported improved communication about sex, an important element to support risk reduction among youth in high-prevalence areas.