[Show abstract][Hide abstract] ABSTRACT: Childhood obesity is a growing problem for children in the United States, especially for children from low-income, African American families.
The purpose of this qualitative study was to understand facilitators and barriers to engaging in healthy lifestyles faced by low-income African American children and their families.
This qualitative study used semi-structured focus group interviews with eight African American children clinically identified as overweight or obese (BMI ≥ 85) and their parents. An expert panel provided insights in developing culturally appropriate intervention strategies.
Child and parent focus group analysis revealed 11 barriers and no definitive facilitators for healthy eating and lifestyles. Parents reported confusion regarding what constitutes nutritional eating, varying needs of family members in terms of issues with weight, and difficulty in engaging the family in appropriate and safe physical activities; to name a few themes. Community experts independently suggested that nutritional information is confusing and, often, contradictory. Additionally, they recommended simple messaging and practical interventions such as helping with shopping lists, meal planning, and identifying simple and inexpensive physical activities.
Childhood obesity in the context of low-resource families is a complex problem with no simple solutions. Culturally sensitive and family informed interventions are needed to support low-income African American families in dealing with childhood obesity.
Frontiers in Pediatrics 12/2014; 2:137. DOI:10.3389/fped.2014.00137
[Show abstract][Hide abstract] ABSTRACT: Approximately two thirds of those older than 60 years have a hypertension diagnosis. The aim of our program, Health Coaches for Hypertension Control, is to improve hypertension self-management among rural residents older than 60 years through education and support offered by trained community volunteers called Health Coaches. Participants received baseline and follow-up health risk appraisals with blood work, educational materials, and items such as blood pressure monitors and pedometers. Data were collected at baseline, 8 weeks, and 16 weeks on 146 participants who demonstrated statistically significant increases in hypertension-related knowledge from baseline to 8 weeks that persisted at 16 weeks, as well as significant improvements in stage of readiness to change behaviors and in actual behaviors. Furthermore, clinically significant decreases in all outcome measures were observed, with statistically significant changes in systolic blood pressure (-5.781 mmHg; p = .001), weight (-2.475 lb; p < .001), and glucose (-5.096 mg/dl; p = .004) after adjusting for multiple comparisons. Although 40.4% of participants met the Healthy People 2020 definition of controlled hypertension at baseline, the proportion of participants meeting this definition at 16 weeks postintervention increased to 51.0%. This article describes a university-community-hospital system model that effectively promotes hypertension self-management in a rural Appalachian community.
Health Promotion Practice 05/2014; 16(2). DOI:10.1177/1524839914533797 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A multidisciplinary team developed and pilot-tested a curriculum, delivered by trained lay educators, to increase self-efficacy for physical activity among elderly food stamp recipients. Curriculum development was guided by a comprehensive literature review. Process evaluation was used to revise the curriculum and to assess lay educator training and pilot test fidelity. Three hundred sixteen low-income older adults participated in curriculum development and pilot-testing activities. One hundred twenty four participants completed pretest/posttest impact evaluation surveys. The average age of participants was 75 years old with 55.28% having less than high school education. Significant increases in self-efficacy regarding walking most days (p = .0022), using exercise bands (p <. 0001), being physically active to increase strength (p = .0012), being active without injury (p <. 0001), being able to wear appropriate clothing and shoes (p <. 0001), and getting information about community physical activity programs (p = .0007) were observed. Participants also endorsed higher ratings of general health at posttest (p <. 0001).
[Show abstract][Hide abstract] ABSTRACT: To develop and validate measures of parental social support to increase their child's fruit and vegetable (FV) consumption.
Cross-sectional study design.
School and home.
Two hundred three parents with at least 1 elementary school-aged child.
Parents completed a questionnaire that included instrumental social support scale (ISSPS), emotional social support scale (ESSPS), household FV availability and accessibility index, and demographics.
Exploratory factor analysis with promax rotation was conducted to obtain the psychometric properties of ISSPS and ESSPS. Internal consistency and test-retest reliabilities were also assessed.
Factor analysis indicated a 4-factor model for ESSPS: positive encouragement, negative role modeling, discouragement, and an item cluster called reinforcement. Psychometric properties indicated that ISSPS performed best as independent single scales with α = .87. Internal consistency reliabilities were acceptable, and test-retest reliabilities ranged from low to acceptable. Correlations between scales, subscales, and item clusters were significant (P < .05). In addition, ISSPS and the positive encouragement subscale were significantly correlated with household FV availability.
The ISSPS and ESSPS subscales demonstrated good internal consistency reliability and are suitable for impact assessment of an intervention designed to target parents to help their children eat more fruit and vegetables.
Journal of nutrition education and behavior 03/2012; 44(2):132-9. DOI:10.1016/j.jneb.2011.07.002 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Develop scales to assess the impact of the Cooking with a Chef program on several psychosocial constructs.
Cross-sectional design in which parents and caregivers were recruited from child care settings (Head Start, faith-based, public elementary schools), and cooks were recruited from church and school kitchens. Analysis involved descriptive statistics, correlations, and exploratory factor analysis.
Test-retest reliability coefficients ranged from r = 0.63 to r = 0.88. Exploratory factor analysis indicated a simple structure for 3 scales: Cooking Techniques Self-Efficacy, Negative Cooking Attitude, and Self-Efficacy Fruit and Vegetables and accounted for 85.0% of the total variance. Mean responses to each scale were not statistically different between parents and cooks.
Evidence of face validity and construct validity were provided through expert review, factor analysis, and scale correlations. Analyses presented constitute the first step in developing psychosocial scales for evaluating the Cooking with a Chef program and provide preliminary evidence that these scales work well with diverse groups.
Journal of nutrition education and behavior 08/2011; 43(6):511-6. DOI:10.1016/j.jneb.2010.09.013 · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Less than half of all US adults report meeting physical activity recommendations of 30 minutes or more of moderate to vigorous physical activity on at least 5 days per week. Thus, community-wide ecological initiatives are needed to create environments that support incorporating physical activity into residents' daily lives. In this article we describe an ongoing collaborative service-learning partnership between Clemson University, a community coalition, and a neighboring small rural town to address local social and physical environment supports for walking. Years 1 to 3 of this collaborative initiative were evaluated using a mixed-method approach to assess physical environment changes, social environment changes, community perceptions of support for walking, community perceptions of collaborating with university students, and students' skill development. Results revealed several key environmental changes such as mapping and marking 3 walking trails in the community, development of broad marketing efforts linked to the trails that promote community health and heritage, and annual community events to promote walking and the newly developed walking trails. Interview data with community leaders identified several key themes critical to facilitating and enhancing our university and community collaboration. Lastly, students developed skills in developing partnerships, mapping, advocacy, event planning, critical reflection, and qualitative and quantitative data collection and analysis. Through this process community members and students learn evidence-based public health skills for using data and planning frameworks to guide local initiatives, engage community members in decision making, and conducting evaluations.
Journal of public health management and practice: JPHMP 07/2011; 17(4):358-62. DOI:10.1097/PHH.0b013e318221471c · 1.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Southeast United States has experienced rapid growth in the Latino population - mostly Mexican immigrants - with the number of Latinos in the region nearly quadrupling over the past decade. These states, known as new settlement areas, are not as well prepared to meet the health needs of Spanish-speaking immigrants compared to traditional settlement states like Florida, Texas, and California. Unfortunately for these families, immigration to the United States is often associated with becoming obese, or having children at a higher risk for obesity. Rates of obesity have risen dramatically among all racial and ethnic groups in the past few decades, however, Latinos of all ages have the highest rates of overweight and obesity compared to other racial and ethnic groups. One explanation is that although adjustment to a new environment and culture takes considerable time, the adoption of a more sedentary lifestyle and unhealthy diet occurs more rapidly, leading to significant increases in obesity between first and subsequent generations. Families are important referents in establishing health behaviors in children, and there are broader social and physical environmental factors that have strong associations with the development of obesity as well. Moreover, immigrant families must strive to be healthy while coping with acculturative stressors. Relationships between all of these factors are typically studied in isolation. This article explores obesity among new settlement Latino families and provides an integrated conceptual model anchored in the social ecological perspective.
[Show abstract][Hide abstract] ABSTRACT: The objective of this project was to examine the determinants of diet-related behaviors and the influences of the environment that drive food choices among Hispanic adults in South Carolina. A series of focus-group interviews found barriers to healthy eating, including limited availability of specific foods, insufficient time, and lack of cooking skills. Participants mentioned the need for education related to portion control, illness prevention, weight control, healthy foods, foods appropriate for children, and reading food labels. Motivators included risk awareness, advice from physicians, family help, and education. These findings provide a basis for developing nutrition education interventions that target Hispanic adults.
Topics in clinical nutrition 12/2009; 25(1):47–59. DOI:10.1097/TIN.0b013e3181d109a0
[Show abstract][Hide abstract] ABSTRACT: Although school-based behavioral interventions for increasing physical activity (PA) in children and adolescents have been conducted, little evidence suggests that these curriculum-based approaches lead to increases in overall activity outside of program days. The overall goal of the "Active by Choice Today" (ACT) trial is to expand the body of knowledge concerning the factors that influence long-term increases in PA in underserved adolescents (low socioeconomic status, minorities) during their middle school years.
An overview of the ACT study design, theoretical framework, process evaluation, and primary hypotheses is presented. The trial involves twenty-four middle schools (1560 6th graders) in South Carolina that are randomly assigned to one of two after-school programs (motivational and life skills intervention, or general health education).
The intervention integrates constructs from Self-Determination and Social Cognitive Theories to enhance intrinsic motivation and behavioral skills for PA. The intervention targets skill development for PA outside of program days and the after-school program social environment (autonomy, choice, participation, belongingness, fun, enjoyment, support) is designed to positively impact cognitive mediators (self-efficacy, perceived competence), and motivational orientation (intrinsic motivation, commitment, positive self-concept). MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the 17-week motivational and life skills intervention will lead to greater increases in moderate-to-vigorous PA (based on 7-day accelerometry estimates) at post-intervention as compared to the general health education program.
Implications of this innovative school-based trial are discussed.
[Show abstract][Hide abstract] ABSTRACT: The purpose was to assess the prevalence and correlates of complementary and alternative medicine use for weight control.
A list-assisted random-digit-dialed telephone survey of adults was conducted in the fall of 2002 (n = 11,211). The focus of the study was complementary and alternative medicine (CAM) use, other than dietary supplements, in the previous 12 months.
The sample of respondents was drawn from the total noninstitutionalized U.S. adult population residing in telephone-equipped locations.
The sampling procedures were designed to obtain adequate representation of Hispanic and non-Hispanic black respondents. Data from the total sample of 11,211 were weighted to achieve an estimate of the U.S. population. Analyses focused on 372 people who had used CAM within the previous 12 months.
Of the total, 3.3% (n = 372) had used a CAM therapy in the previous 12 months. Higher adjusted odds ratios for CAM use were found among respondents who were exercising for weight control; using a lower carbohydrate, higher protein diet; using a nonprescription weight-loss product(s); overweight; physically active; and not satisfied with one's body (adjusted for age, race, gender, education, and city size). The most often used therapies were yoga (57.4%), meditation (8.2%), acupuncture (7.7%), massage (7.5%), and Eastern martial arts (5.9%). CAM users used CAM therapies on their own (62.6%), in a group setting (26.8%) or with a CAM practitioner (10.6%).
The use of CAM therapies other than dietary supplements for weight loss was relatively low. The most popular therapy was yoga, and the majority of CAM users used CAM therapies on their own. Persons who had used other weight loss methods had greater odds for using CAM in the previous 12 months, suggesting that CAM use is often added to other weight-loss strategies.
The Journal of Alternative and Complementary Medicine 04/2007; 13(2):217-22. DOI:10.1089/acm.2006.6129 · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The importance of regular physical activity is well documented, yet according to epidemiological surveillance data, physical inactivity among all age groups persists. Past attempts to promote physical activity focused on individual-level changes; current approaches focus on environmental changes that will provide opportunities for whole communities to be active. The current ecological focus has led to an increase in funding and research regarding environmental supports of physical activity. As this is a new area of research, much work needs to be done to improve the ability to assess environmental features that support physical activity. This article describes a partnership between researchers and community members to develop and test an objective tool to measure sidewalk maintenance. Community members used data collected with the tool to increase awareness about sidewalk maintenance issues among local policy makers. Collaboration between researchers and community partners was critical for the success of this study.
Health Promotion Practice 02/2005; 6(1):81-8. DOI:10.1177/1524839903260595 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of a geographic information system (GIS) to study environmental supports for physical activity raises several issues, including acquisition and development, quality, and analysis.
We recommend to public health professionals interested in using GIS that they investigate available data, plan for data development where none exists, ensure the availability of trained personnel and sufficient time, and consider issues such as data quality, analyses, and confidentiality.
This article shares information about data-related issues that we encountered when using GIS to validate responses to a questionnaire about environmental supports for physical activity.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to develop a tool for assessing the quality of public recreation facilities’ amenities. Knowing the location, distribution, and quality of recreation facilities can assist administrators in developing more effective programs for encouraging physical activity across city, county, and state systems. Based on a literature review, expert opinions, and professional standards, a tool was developed for assessing the safety, condition, and maintenance of recreation facilities. A Geographic Information System (GIS) database was developed to locate public recreation facilities in a southeastern county of the United States. Objective ratings of recreation facility quality were computed from the tool. Items on the tool were tested for inter-rater reliability among three independent raters. The findings demonstrated that overall the items in the tool were reliable and effective in evaluating objective physical features of the recreation facilities. Total Quality Management systems would benefit from the addition of an objective component to the evaluation of facility quality. The tool also provides a means of evaluating park quality over time, and can be modified to focus on users of particular ages, or for families versus individual users. Parks and recreation agencies have an important role to play in developing environmental supports for physical activity that may aid in reducing the national epidemic of obesity and related chronic diseases.
[Show abstract][Hide abstract] ABSTRACT: Valid assessment of physical activity is necessary to fully understand this important health-related behaviour for research, surveillance, intervention and evaluation purposes. This article is the second in a companion set exploring the validity of pedometer-assessed physical activity. The previous article published in Sports Medicine dealt with convergent validity (i.e. the extent to which an instrument's output is associated with that of other instruments intended to measure the same exposure of interest). The present focus is on construct validity. Construct validity is the extent to which the measurement corresponds with other measures of theoretically-related parameters. Construct validity is typically evaluated by correlational analysis, that is, the magnitude of concordance between two measures (e.g. pedometer-determined steps/day and a theoretically-related parameter such as age, anthropometric measures and fitness). A systematic literature review produced 29 articles published since > or =1980 directly relevant to construct validity of pedometers in relation to age, anthropometric measures and fitness. Reported correlations were combined and a median r-value was computed. Overall, there was a weak inverse relationship (median r = -0.21) between age and pedometer-determined physical activity. A weak inverse relationship was also apparent with both body mass index and percentage overweight (median r = -0.27 and r = -0.22, respectively). Positive relationships regarding indicators of fitness ranged from weak to moderate depending on the fitness measure utilised: 6-minute walk test (median r = 0.69), timed treadmill test (median r = 0.41) and estimated maximum oxygen uptake (median r = 0.22). Studies are warranted to assess the relationship of pedometer-determined physical activity with other important health-related outcomes including blood pressure and physiological parameters such as blood glucose and lipid profiles. The aggregated evidence of convergent validity (presented in the previous companion article) and construct validity herein provides support for considering simple and inexpensive pedometers in both research and practice.
Sports Medicine 01/2004; 34(5):281-91. DOI:10.2165/00007256-200434050-00001 · 5.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perceptions of the environment and physical activity have been associated using survey methods, yet little is known about the validity of environmental surveys. In this study, perceptions of the environment at neighborhood and community levels were assessed (1) to determine validity by comparing respondent perceptions to objective measures and (2) to determine test-retest reliability of the survey.
A telephone survey was administered to a stratified sample of Sumter County, South Carolina adults. Respondents' home addresses were mapped using a geographic information system (GIS) (n =1112). As an indicator of validity, kappa statistics were used to measure agreement between perceptions and objective measures identified at neighborhood and community levels using GIS. A second survey in an independent sample (n=408) assessed test-retest reliability.
When assessing perceptions of environmental and physical activity in a defined geographic area, validity and reliability for neighborhood survey items were kappa= -0.02 to 0.37 and rho=0.42 to 0.74, and for community survey items were kappa= -0.07 to 0.25 and rho=0.28 to 0.56.
Although causality between perception of access and safety and actual physical activity level cannot be assumed, those meeting national physical activity guidelines or reporting some physical activity demonstrated greatest agreement with access to recreation facilities, while those not meeting the guidelines demonstrated greater agreement with safety of recreation facilities. Factors such as distance and behavior may explain differences in perceptions at neighborhood and community levels. Using local environments with short distances in survey methods improves validity and reliability of results.
American Journal of Preventive Medicine 06/2003; 24(4):323-31. DOI:10.1016/S0749-3797(03)00021-7 · 4.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Valid assessment of physical activity is important to researchers and practitioners interested in surveillance, screening, programme evaluation and intervention. The validity of an assessment instrument is commonly considered its most important attribute. Convergent validity is the extent to which an instrument's output is associated with that of other instruments intended to measure the same exposure of interest. A systematic review of the literature produced 25 articles directly relevant to the question of convergent validity of pedometers against accelerometers, observation, and self-reported measures of physical activity. Reported correlations were pooled and a median r-value was computed. Pedometers correlate strongly (median r = 0.86) with different accelerometers (specifically uniaxial accelerometers) depending on the specific instruments used, monitoring frame and conditions implemented, and the manner in which the outputs are expressed. Pedometers also correlate strongly (median r = 0.82) with time in observed activity. Time in observed inactivity correlated negatively with pedometer outputs (median r = -0.44). The relationship with observed steps taken depended upon monitoring conditions and speed of walking. The highest agreement was apparent during ambulatory activity (running, walking) or during sitting (when both observation and pedometers would register few steps taken). There was consistent evidence of reduced accuracy during slow walking. Pedometers correlate moderately with different measures of energy expenditure (median r = 0.68). The relationship between pedometer outputs and energy expenditure is complicated by the use of many different direct and indirect measures of energy expenditure and population samples. Concordance with self-reported physical activity (median r = 0.33) varied depending upon the self-report instrument used, individuals assessed, and how pedometer outputs are expressed (e.g. steps, distance travelled, energy expenditure). Pedometer output has an inverse relationship with reported time spent sitting (r = -0.38). The accumulated evidence herein provides ample support that the simple and inexpensive pedometer is a valid option for assessing physical activity in research and practice.
Sports Medicine 02/2002; 32(12):795-808. DOI:10.2165/00007256-200232120-00004 · 5.32 Impact Factor