Suchergebnisse

In spite of the well-known benefits of physical activity, the vast majority of children in North America do not meet current international guidelines for accumulating sufficient health-enhancing physical activity. Indeed, despite considerable attention to this population health crisis, the current prevalence of inactivity, along with its concomitant health consequences, shows little sign of abating. In this paper, we identify acknowledged barriers to wide scale physical activity adoption and maintenance at the population level among children and propose a viable tripartite framework (albeit one that would require political support) that we hope will provide the basis for debate and implementation. We emphasize that each of these considerations, in isolation, would be insufficient to substantively address the problem, but when combined would ensure that all elementary school children (without any medical contraindication) are sufficiently active, rather than the minority of this population.

In spite of the well-known benefits of physical activity, the vast majority of children in North America do not meet current international guidelines for accumulating sufficient health-enhancing physical activity. Indeed, despite considerable attention to this population health crisis the current prevalence of inactivity, along with its concomitant health consequences, shows little sign of abating. In this paper we identify acknowledged barriers to wide scale physical activity adoption and maintenance at the population level among children, and propose a viable tripartite framework (albeit one that would require political support) that we hope will provide the basis for debate and implementation. We emphasize that each of these considerations, in isolation, would be insufficient to substantively address the problem, but when combined would ensure that all elementary school children (without any medical contraindication) are sufficiently active, rather than the minority of this population. ; Education, Faculty of ; Non UBC ; Kinesiology, School of ; Reviewed ; Faculty

Purpose. There is little scholarship on physical activity among children within outdoor spaces and work is needed to advance the design of these spaces from "best practices" towards evidence-based design. This project examined how playground feature density relates to children's physical activity. Design. We used the System for Observing Play and Leisure Activity to observe children's physical activity. Setting. We observed children during school recess on 24 school grounds in the Denver metropolitan area of Colorado, in spring of 2010 and 2011. Subjects. A total of 31,069 observations were made from an estimated 9900 children aged 5 to 12. These were aggregated and analyzed in 397 playground zones. Measures. We examined utilization, the number of children present in a particular activity zone during an observation, and the percentage of children engaged in moderate to vigorous physical activity as they relate to the density of constructed features on school playgrounds. Analysis. Ordinary least-squares linear regression model assessed the relationship between playground feature density and the utilization and moderate to vigorous physical activity. Results. Significant positive associations were observed between utilization and feature density among all children (β = .20; p < .001) and a statistically significant but small association was observed between moderate to vigorous physical activity and feature density for girls (β = .12; p = .013), but not for boys. Conclusion. This analysis contributes to evidence that design features of play spaces may influence children's behavior within school grounds.

Purpose. To determine if changes in physical activity were associated with changes in fruit and vegetable intake. Design. Prospective cohort. Setting. Hawaii. Subjects. Seven hundred adults (18+ years) sampled from the general population. Measures. Computer-assisted telephone interviews conducted at 0, 3, 6, 9, 12, 18, and 24 months; the International Physical Activity Questionnaire; the National Cancer Institute's Fruit and Vegetable Screener. Analysis. Between-individual correlations of each individual's mean physical activity and mean fruit and vegetable intake were estimated with Pearson correlations. Correlations of physical activity and fruit and vegetable intake within individuals over time were calculated from analysis of covariance models to factor out the variation between individuals. Results. Individuals with a higher mean physical activity duration tended to eat more fruits and vegetables (r =.30, p < .0001). Within individuals, no average correlation between physical activity and intake of fruit and vegetables was observed over time (r =.03). The variation was great in that some individuals, these behaviors changed simultaneously, but in others, they did not. Conclusion. Although individuals who are more physically active tend to eat more fruits and vegetables (i.e., there is a weak correlation between individuals), on average, individuals do not simultaneously change these behaviors. Implications are that health behaviors may not covary, or that intervention is necessary to bring about covariation in health behaviors. The great variation from individual to individual in the extent to which these two behaviors covaried needs to be studied to determine if the individual tendency for behaviors to covary could be measured and used to individually tailor multiple behavior interventions.

Purpose. To determine whether Transtheoretical Model (TTM) constructs differ between individuals making successful versus unsuccessful stage transitions for consumption of five or more servings of fruit and vegetables each day and thus provide a useful basis for designing health promotion interventions. Design. Longitudinal, observational study. A randomly selected, multiethnic cohort of adults assessed at 6-month intervals over 2 years. Setting. General community, Hawaii. Subjects. There were 700 participants (62.6% female; mean = 47 ± 17.1 years; 31.1% Asian, 22.1% Native Hawaiian/Pacific Islander, 35.0% Caucasian; 25.1% participation rate). Measures. Stage of readiness, experiential and behavioral processes of change, pros, cons, self-efficacy, and self-reported fruit and vegetable consumption. Analysis. The study used t-tests to determine which TTM variable scores differed consistently between those making "successful" versus "unsuccessful" stage transitions from precontemplation, preparation, and maintenance. Sample sizes for contemplation and action prohibited similar analyses. Results. Compared to those remaining in precontemplation, individuals successfully progressing from precontemplation showed significantly greater use of behavioral processes (collectively and self-liberation) and consciousness raising (p < .001). However, only self-liberation demonstrated significant differences consistently over time. Conclusion. This longitudinal investigation reveals that TTM behavioral processes, particularly self-liberation, predict successful transition out of precontemplation for adult fruit and vegetable consumption, suggesting that public health messages tailored according to these TTM variables may be effective for this group. However, for adults prepared to adopt or maintain fruit and vegetable consumption, tailoring based on variables from other theories is needed.

Combat exposure among military personnel results in increased risk of posttraumatic stress disorder (PTSD), major depression, substance use, and related health risks. PTSD symptoms require innovative approaches to promote effective coping postdeployment. PTSD's nature and scope requires an approach capable of integrating multiple health risks while reaching large populations. This article provides the rationale and approach to adapt and evaluate a Pro-Change computerized tailored intervention (CTI) targeted at behavioral sequelae (i.e., smoking, stress, and depression) for veterans with or at risk for PTSD. The three-phase approach includes: 1) focus groups to review and, subsequently, adapt content of the existing CTI programs; 2) usability testing; and 3) feasibility testing using a three-month pre–postdesign. Effective, theory-based, real-time, multiple behavior interventions targeting veterans' readiness to quit smoking, manage stress, and depression are warranted to provide potential health impact, opportunities for learning veteran-specific issues, and advance multiple health behavior change knowledge.

Purpose. Test the applicability of the transtheoretical model (TTM) to adult fruit/vegetable consumption. Design. Cross-sectional random-digit dial survey. Setting. Hawaii. Subjects. 700 (62.6% female; age [mean ± SD], 47 ± 17.1 years; education [mean ± SD], 14.6 ± 2.8 years; 35.0% white, 31.1% Asian, 22.1% native Hawaiian/Pacific Islander, 11.8% other). Measures. Stages, processes, self-efficacy, decisional balance, and self-reported fruit/vegetable consumption. Analysis. Confirmatory factor analysis tested the factor structure. Analyses of variance were used to explore stage differences in constructs. Results. Stage distribution was precontemplation (33%), contemplation (4%), preparation (37%), action (3%), and maintenance (23%). A 10-factor process model with two higher-order correlated factors (experiential and behavioral) provided the best data fit (X2 = 1446.12; df = 366; p < .0001; comparative fit index [CFI] = .89; standardized root mean square residual [SRMR] = .05). The self-efficacy structure fit the data well (X2 = 81.86; df = 9; p < .0001; CFI = .94; SRMR = .04), as did the decisional balance structure (X2 = 37.42; df = 19;p = .007; CFI = .99; SRMR = .02). Processes, self-efficacy, decisional balance, and fruit/vegetable consumption behavior differed significantly by stage, with medium effect sizes for most variables. Conclusion. The variables revealed adequate fit to the theorized measurement models. TTM predictions regarding stage differences in self-efficacy, pros and cons, and fruit/vegetable consumption were confirmed; however, most experiential and behavioral processes increased in the early stages and then leveled off.

Purpose. We assessed the effectiveness of a worksite management intervention (the 3W program) for overweight and obese hotel employees. Design. The program was tested in a 2-year cluster-randomized trial involving 30 hotels that employed nearly 12,000 individuals. Setting. All participating hotels were on Oahu, Hawaii. The intervention was implemented within hotel worksites. Subjects. Participants were included in the analysis if they had an initial body mass index (BMI) ≥ 25, were assessed at least twice, were not missing other data needed for the analysis, and did not switch to employment at a hotel in a different experimental condition. Of the 6519 employees we assessed, data from 1207 individuals (intervention: 598; control: 610) met these criteria and contributed to the analysis. Intervention. The intervention had two components: (1) group meetings and (2) a workplace environment intervention. Measures. Weight and waist to height ratio (WHtR) were measured at three annual assessments. Analysis. The effect of the intervention on change in BMI and WHtR was estimated in hierarchical mixed regression models using full maximum likelihood to estimate model parameters. Results. The effects on change in BMI and WHtR were in the expected direction but were not statistically significant. Conclusion. The 3W program was not effective. The low intensity of the intervention may have contributed to its ineffectiveness.

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.

Purpose. To examine whether the stages of change of exercise adoption appropriately address strenuous, moderate, and mild intensities of physical activity. Design and Setting. Secondary analysis of four data sets investigating transtheoretical model (TTM) constructs for exercise adoption. Subjects. Four samples of differing age groups (adolescents, n = 400; college students, n = 240; adults, n = 346; seniors, n = 504). Measures. Stage of change algorithm for exercise adoption and self-reported physical activity. Results. Multivariate analysis of variance (MANOVA) results showed that stages of change were distinguished by strenuous and moderate but not mild exercise in the adolescent, college student, and adult sample. In the senior sample, stage differences were found in the frequency of exercising (equivalent for moderate to strenuous exercise) and the frequency of walking (equivalent for mild exercise). Bivariate correlation coefficients as well as sensitivity, specificity, and related quality indices decreased respectively from strenuous to moderate to mild exercise and from exercising to walking. Conclusions. Results provide additional support for the construct validity of the stages of change for strenuous and moderate intensities of physical activity. Development of a new stage assessment instrument for mild intensities of physical activity is recommended. Limitations include use of a different validation measure of exercise behavior in the senior sample.

"It is recommended that researchers who use mixed modal methods for data collection compare their impact on outcome measures. The purpose of this study was to examine the physical activity and fruit/ vegetable consumption behaviors of a multiethnic sample of adults, comparing participants who continued a telephone survey and those who transitioned from a telephone to a web-based survey for a follow-up data collection point. This longitudinal study used a random sample of 700 Hawaii residents (63.3% Female; Mean age=47, SD=17.1). At baseline, participants completed a computer-assisted telephone interview assessing the stage, behavior, and decisional balance of both physical activity and fruit/ vegetable consumption. For the three-month follow-up survey, participants were given the option of completing the survey either on the web or by phone. Repeated measures analysis of variance (ANOVA) was computed for related physical activity scales and fruit/ vegetable consumption variables to compare the change in response across time between a web group and phone group. For both physical activity and fruit/ vegetable consumption, all mode-by-time interactions were significant). The participants who preferred the telephone survey maintained their levels, whereas those who preferred the web survey reported a decrease in each variable. These results suggest that changing the mode of a survey may introduce a systematic bias in data and that researchers should proceed with caution when using mixed modes of data collection." (author's abstract)