Health Education Research - Advance Access

Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public

Fri, 06 Nov 2009 02:29:36 PST

The Internet has become important for the delivery of behavior change interventions. This observational study examines how many people visited, registered and revisited a web-based computer-tailored intervention promoting heart-healthy behaviors when it is implemented for use by the general public. Among registered visitors, the association between visitors’ characteristics and initiating, completing and revisiting the website and/or its behavior-specific modules was analyzed. Server statistics showed that 285 146 visitors from unique IP addresses landed on the home page in a 36-month period; of these, >50% left the intervention website within 30 s. In total, 81 574 (28.6%) visitors completed the registration procedure and gained access to the intervention; 99% of registered visitors initiated one module, 91% completed at least one module and 6% revisited the intervention. The majority of the registered visitors were women, medium to highly educated, with a body mass index (BMI) <25. Women, visitors aged 40–50 years, visitors with a medium educational level and visitors with a BMI <25 were more likely to initiate and finish the modules. It is concluded that a heart-healthy computer-tailored Internet program can reach substantial numbers of people, but additional research is needed to develop promotional strategies that reach the high-risk population, i.e. men, older and lower educated persons.

Participation rates and representativeness of African Americans recruited to a health promotion program

Thu, 29 Oct 2009 13:14:07 PDT

When using community-based participatory methods to develop health promotion programs for specific communities, it is important to determine if participation differs based on sociodemographics and the extent to which program participants are demographically representative of the target community, especially when non-random recruitment methods are used. We evaluated rates of participating in a health promotion program among African American residents in an urban community and determined if program participants were representative of community residents in terms of sociodemographic factors. While participation in the program was modest, participation did not differ based on psychological factors or body mass index. However, individuals who were unemployed were significantly more likely to participate in the program compared with those who were employed. Our sample included a greater proportion of individuals who only had a high school education compared with community residents but was similar to community residents in terms of gender, marital status and employment.

Longitudinal analysis of domain-level breast cancer literacy among African-American women

Mabiso, A., Williams, K. P., Todem, D., Templin, T. N. — Tue, 27 Oct 2009 12:08:09 PDT

Functional breast cancer literacy was assessed among African-American women and measured at the domain level over time. We used the Kin Keeper^SM Cancer Prevention Intervention to educate 161 African-American women on three domains of breast cancer literacy: (i) cancer awareness, (ii) knowledge of breast cancer screening modalities and (iii) cancer prevention and control. A breast cancer literacy assessment was administered pre- and post-educational intervention at two time points followed by another assessment 12 months after the second intervention. Generalized estimating equations were specified to predict the probability of correctly answering questions in each domain over time. Domain-level literacy differentials exist; at baseline, women had higher test scores in the breast cancer prevention and control domain than the cancer awareness domain (odds ratio = 1.67, 95% confidence interval 1.19–2.34). After Kin Keeper^SM Cancer Prevention Intervention, African-American women consistently improved their breast cancer literacy in all domains over the five time stages (P < 0.001) though at different rates for each domain. Differences in domain-level breast cancer literacy highlight the importance of assessing literacy at the domain level. Interventions to improve African-American women's breast cancer literacy should focus on knowledge of breast cancer screening modalities and cancer awareness domains.

What influences the uptake of information to prevent skin cancer? A systematic review and synthesis of qualitative research

Garside, R., Pearson, M., Moxham, T. — Sun, 25 Oct 2009 20:42:52 PDT

Skin cancer is an increasing problem in Europe, America and Australasia, although largely preventable by avoiding excessive ultraviolet (UV) exposure. This paper presents the findings of a systematic review of qualitative research about the prevention of skin cancer attributable to UV exposure. The aim is to understand elements that may contribute to the successful or unsuccessful conveyance of skin cancer prevention messages and their uptake by the public. A systematic review was undertaken using evidence identified through searching electronic bibliographic databases and Web sites and reference list checks. Predefined inclusion and exclusion criteria were used. Sixteen study reports (relating to 15 separate studies) were included from the United Kingdom, United States, Australia, Canada and New Zealand. Each included study was quality appraised, and the findings were extracted into an evidence table. A coding scheme, framed by the Health Belief Model, was developed by the reviewers and informed analysis and synthesis. This showed that most people perceived their susceptibility to skin cancer, and its severity, as low. While benefits of adopting changed behaviour were acknowledged, there were substantial barriers to this, including positive perceptions of a tan as healthy and attractive and the hassle of covering up or using sunscreen. Peers, parents and media may offer ‘cues to action’ that encourage adoption of preventative behaviour and finally self-efficacy or the perceived ability to make such changes. Effective health education messages will need to address the barriers to adopting protective behaviours identified through this review.

Does a typical contemplator exist? Three clusters of smokers in contemplation

Smit, E. S., Hoving, C., de Vries, H. — Wed, 21 Oct 2009 03:13:12 PDT

The aim of this study is to test whether subtypes exist among smokers in contemplation. Data from 194 adult smokers that participated in a randomized controlled trial testing the effectiveness of a computer-tailored smoking cessation program in Dutch general practices were used for secondary analysis. Cluster analysis was conducted based on baseline scores on pros and cons of quitting and self-efficacy to quit. Clusters were cross-sectionally compared for demographic variables and smoking characteristics with analyses of variance (ANOVA) and Chi-square tests. Logistic and multinomial regression analyses were used for longitudinal comparison for smoking behavior and stage of change at 6 months follow-up. Three clusters were identified: Early, Progressing and Disengaged Contemplators. Clusters differed significantly on all clustering variables (P < 0.001). Disengaged smokers were significantly less addicted than Early Contemplators. Cluster membership was not predictive of outcome measures. No subtype was identified representing the Classic Contemplator, scoring high on both pros and cons of quitting and low on self-efficacy, as found in previous studies among US samples. The predictive validity of the clusters found was limited.

Balancing rigor against the inherent limitations of investigating hard-to-reach populations

Crosby, R. A., Salazar, L. F., DiClemente, R. J., Lang, D. L. — Mon, 19 Oct 2009 07:27:33 PDT

Maintaining rigor in research is critical; however, this need must be balanced by the necessity of conducting studies in populations where inherent barriers exist relative to key issues such as recruitment, attrition, sampling, sample size, assessment techniques, psychometric rigor, the identification of mediators and moderators and the practical relevance of the research question itself. Ultimately, the value of a study in health promotion should be judged on the practicality of the research question within the context of the target population. Striking the perfect balance between rigor and practicality to the field is a question that health promotion researchers and professionals need to determine through ongoing dialogue and debate.

Investigating message-framing effects in the context of a tailored intervention promoting physical activity

van 't Riet, J., Ruiter, R. A. C., Werrij, M. Q., de Vries, H. — Mon, 19 Oct 2009 07:27:32 PDT

Health-promoting messages can be framed in terms of the gains associated with healthy behaviour or the losses associated with unhealthy behaviour. It has been argued that gain-framed messages promoting physical activity (PA) are more effective than loss-framed messages, but empirical findings are inconsistent. Also, no previous studies investigated the effects of gain- and loss-framed messages in the context of a computer-tailored PA intervention. In this study, we provided participants with computer-generated tailored feedback concerning their PA levels. In total, 787 participants entered in the study, of whom 299 completed all measures at a 3-month follow-up. We investigated whether gain- and loss-framed messages promoting PA affected information acceptance, attitude, intention and behaviour differently. The results showed that gain-framed messages resulted in stronger intentions to be physically active than loss-framed messages. This did not result in a significant increase in actual PA, however, as measured by a 3-month follow-up assessment. For information acceptance and attitude, a non-significant advantage of gain-framed messages was found. All effects had small effect sizes. Thus, whereas gain-framed information might be more persuasive than loss-framed information when it comes to promoting PA, the differences between gain- and loss-framed messages are likely to be small.

Factors influencing the adoption of a Health Promoting School approach in the province of Quebec, Canada

Deschesnes, M., Trudeau, F., Kebe, M. — Mon, 19 Oct 2009 07:27:31 PDT

This study examined a prediction model that integrated three categories of predictors likely to influence adoption of the Quebec Healthy Schools (HS) approach, i.e. attributes of the approach, individual and contextual characteristics. HS receptivity was considered as a potential mediator. For this study, 141 respondents representing 96 schools participated in a postal survey. We used bivariate logistic regression to assess factors associated with HS adoption and Baron and Kenny's method to test the mediation effect of HS receptivity. Four predictors related to school organizational characteristics had more weight in influencing the adoption of HS: the ‘presence of leaders within schools’, ‘perceived school contextual barriers’, ‘school investment in healthy lifestyles’ and ‘beliefs in collective efficacy’. The influence of the latter two predictors was not direct but mediated by HS receptivity. Our findings showed that standard attributes generally considered as predictors of the adoption of an innovation are not the strongest determinants to explain HS adoption in the present context. The results shed light on the crucial role of organizational context in the adoption of this type of approach.

Process evaluation of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) in rural South Africa

Thu, 01 Oct 2009 03:34:27 PDT

The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) combines microfinance, gender/HIV training and community mobilization (CM) in South Africa. A trial found reduced intimate partner violence among clients but less evidence for impact on sexual behaviour among clients’ households or communities. This process evaluation examined how feasible IMAGE was to deliver and how accessible and acceptable it was to intended beneficiaries during a trial and subsequent scale-up. Data came from attendance registers, financial records, observations, structured questionnaires (378) and focus group discussions and interviews (128) with clients and staff. Gender/HIV training and CM were managed initially by an academic unit (‘linked’ model) and later by the microfinance institution (MFI) (‘parallel’ model). Microfinance and gender/HIV training were feasible to deliver and accessible and acceptable to most clients. Though participation in CM was high for some clients, others experienced barriers to collective action, a finding which may help explain lack of intervention effects among household/community members. Delivery was feasible in the short term but both models were considered unsustainable in the longer term. A linked model involving a MFI and a non-academic partner agency may be more sustainable and is being tried. Feasible models for delivering microfinance and health promotion require further investigation.

Does socio-economic status moderate the associations between psychosocial predictors and fruit intake in schoolchildren? The Pro Children study

Sandvik, C., Gjestad, R., Samdal, O., Brug, J., Klepp, K.-I. — Thu, 24 Sep 2009 05:10:09 PDT

This study tested whether socio-economic status (SES) moderated the association between the psychosocial constructs included in the attitude–social influence–self-efficacy (ASE) model and fruit intake in Norwegian schoolchildren. The sample consisted of 962 Norwegian sixth graders, mean age 11.3 years. They were split into three SES groups, and multi-group structural equation modeling (MSEM) was used. Children in the highest SES group reported eating fruit more frequently and reported more positive ASE variables than children in the lower SES groups. This was particularly true for social environmental factors, home availability of fruit and intention to eat fruit. MSEM showed that the relationships specified in the adapted ASE model were moderated by SES, as we did not find support for equal model structure across the three samples. Model modification for each SES group separately showed that the relation between home availability and fruit intake was not significant for the medium and low SES groups, and the relation between self-efficacy and intention to eat fruit was not significant for the medium SES group. Future interventions aiming at increasing fruit intake in children need to be sensitive to such SES-related differences and should in particular affect factors that may impede fruit intake in the lower SES groups.

Physical activity, emotional and behavioural problems, maternal education and self-reported educational performance of adolescents

Kantomaa, M. T., Tammelin, T. H., Demakakos, P., Ebeling, H. E., Taanila, A. M. — Thu, 17 Sep 2009 00:56:07 PDT

This study examined whether physical activity, mental health and socio-economic position were associated with the overall academic performance and future educational plans of adolescents aged 15–16 years. We used a sample of 7002 boys and girls from the Northern Finland Birth Cohort 1986. Data were collected by a postal enquiry in 2001–02. Multivariable logistic regression models were estimated and adjusted for family structure and all variables in the models. In the fully adjusted models, higher levels of physical activity and high parental socio-economic position were associated with higher overall academic performance and future plans for higher education. High scoring on behavioural problems was related to lower overall academic performance and poorer future academic plans. In summary, a higher level of physical activity, fewer behavioural problems and higher socio-economic position were independently associated with high self-perceived overall academic performance and plans for higher education among adolescents. The interrelations of these factors and the positive relationship between physical activity, mental health and school outcomes provide a context of critical importance for future research, intervention programming and policy directed at improving the educational attainment of adolescents.

Interviewer effects in public health surveys

Davis, R. E., Couper, M. P., Janz, N. K., Caldwell, C. H., Resnicow, K. — Thu, 17 Sep 2009 00:56:06 PDT

Interviewer effects can have a substantial impact on survey data and may be particularly operant in public health surveys, where respondents are likely to be queried about racial attitudes, sensitive behaviors and other topics prone to socially desirable responding. This paper defines interviewer effects, argues for the importance of measuring and controlling for interviewer effects in health surveys, provides advice about how to interpret research on interviewer effects and summarizes research to date on race, ethnicity and gender effects. Interviewer effects appear to be most likely to occur when survey items query attitudes about sociodemographic characteristics or respondents’ engagement in sensitive behaviors such as substance use. However, there is surprisingly little evidence to indicate whether sociodemographic interviewer–respondent matching improves survey response rates or data validity, and the use of a matched design introduces possible measurement bias across studies. Additional research is needed to elucidate many issues, including the influence of interviewers’ sociodemographic characteristics on health-related topics, the role of within-group interviewer variability on survey data and the simultaneous impact of multiple interviewer characteristics. The findings of such research would provide much-needed guidance to public health professionals on whether or not to match interviewers and respondents on key sociodemographic characteristics.

The effect of a multi-strategy workplace physical activity intervention promoting pedometer use and step count increase

De Cocker, K. A., De Bourdeaudhuij, I. M., Cardon, G. M. — Sun, 13 Sep 2009 20:21:04 PDT

Pedometer use and step count goals have become popular in physical activity (PA) interventions in different settings. Previous pedometer-based workplace interventions were short term, uncontrolled and executed outside Europe. This European quasi-experimental study evaluated the effects of a 20-week pedometer-based PA workplace intervention. Pedometer-based and self-reported PA from one intervention worksite (68 participants at follow-up) was compared with the data of a comparison workplace (79 participants at follow-up). A downward trend in overall step counts from baseline (end of summer) to follow-up (winter) was found (F = 3.3, P = 0.071). However, the intervention effect revealed a significant smaller decrease in the intervention workplace (–618 steps/day) than in the comparison workplace (–1389 steps/day) (F = 8.8, P = 0.004). This intervention effect was only present in already active participants, reaching 10 000 steps/day at baseline (intervention participants: –1706 steps/day; comparison participants: –4006 steps/day) (F = 5.5, P = 0.023). Overall project awareness was very high (97%) and the intervention strategies were judged ‘good to very good’ by 57–95% of the participants. However, the proportion of intervention participants reporting that they had changed their PA behavior because of the intervention (31%) and reporting that they had used the pedometer during the intervention (48%) was limited. Future workplace projects should give extra attention to inactive employees.

Impact of a campaign on the public's attitudes towards depression

Dietrich, S., Mergl, R., Freudenberg, P., Althaus, D., Hegerl, U. — Sun, 13 Sep 2009 20:21:04 PDT

A public campaign was launched in 2000 as part of the four-level community-based intervention ‘Nuremberg Alliance Against Depression’ (NAD) in Nuremberg, Germany. Evaluation results will be presented. A baseline survey was done before the campaign in Nuremberg and Wuerzburg (control region), two surveys followed 10 and 22 months after the implementation. Multiple regression analyses were performed, with time, place and the interaction of time and location as independent and the corresponding items as dependent variables. For the general population, the campaign was successful in creating awareness for the NAD. For persons who reported experience with depression and persons aware of the NAD, analyses showed positive desirable effects: more awareness of depression and the NAD. In addition, among those aware, more positive attitudes towards medication treatment and antidepressants developed and also ‘lack of self-discipline’ declined as causal explanation as did the notion ‘pull yourself together’ as treatment option. The campaign induced relevant changes mainly in persons aware of the NAD and persons who reported to have had experience with depression. The fact that many of the changes in the general population declined in the second year of the campaign, when activities were done with lower intensity, illustrates the need for permanent depression awareness action.

Newspaper content analysis in evaluation of a community-based participatory project to increase physical activity

Granner, M. L., Sharpe, P. A., Burroughs, E. L., Fields, R., Hallenbeck, J. — Sun, 13 Sep 2009 20:21:03 PDT

This study conducted a newspaper content analysis as part of an evaluation of a community-based participatory research project focused on increasing physical activity through policy and environmental changes, which included activities related to media advocacy and media-based community education. Daily papers (May 2003 to December 2005) from both the intervention and comparison counties were reviewed for topics related to physical activity and an active living environment (e.g. safety, policy, urban design, transportation and recreational resources). A total of 2681 articles from 1764 newspapers were analyzed. The intervention county had a greater proportion of articles on the selected topics. Specifically, the intervention county had a greater proportion of articles in topics related to safety, policy and community initiatives, as well as in sidewalks and recreational facilities; both priority areas for the intervention. Prominence of the articles was assessed using a composite index score. Generally, prominence of the topics analyzed was low. Articles in the sidewalks and recreational facilities topic category in the intervention county had higher prominence scores on average than the comparison county. The study demonstrates that media content analysis can be a valuable component in evaluating community-based interventions.

Portion size: a qualitative study of consumers' attitudes toward point-of-purchase interventions aimed at portion size

Vermeer, W. M., Steenhuis, I. H. M., Seidell, J. C. — Fri, 11 Sep 2009 05:14:50 PDT

This qualitative study assessed consumers’ opinions of food portion sizes and their attitudes toward portion-size interventions located in various point-of-purchase settings targeting overweight and obese people. Eight semi-structured focus group discussions were conducted with 49 participants. Constructs from the diffusion of innovations theory were included in the interview guide. Each focus group was recorded and transcribed verbatim. Data were coded and analyzed with Atlas.ti 5.2 using the framework approach. Results showed that many participants thought that portion sizes of various products have increased during the past decades and are larger than acceptable. The majority also indicated that value for money is important when purchasing and that large portion sizes offer more value for money than small portion sizes. Furthermore, many experienced difficulties with self-regulating the consumption of large portion sizes. Among the portion-size interventions that were discussed, participants had most positive attitudes toward a larger availability of portion sizes and pricing strategies, followed by serving-size labeling. In general, reducing package serving sizes as an intervention strategy to control food intake met resistance. The study concludes that consumers consider interventions consisting of a larger variety of available portion sizes, pricing strategies and serving-size labeling as most acceptable to implement.

The identification of framed messages in the New York State Smokers' Quitline materials

Wed, 05 Aug 2009 00:35:04 PDT

Research suggests that smoking cessation messages are most persuasive when framed in terms of the benefits achieved from quitting (i.e. gain-framed) than when framed in terms of the costs of not quitting (i.e. loss-framed). It is unknown, however, if these findings about optimal message frames have been translated into public health practice. The current study examined message framing in telephone counseling sessions with smokers calling the New York State Smokers’ Quitline (NYSSQ). We conducted a content analysis of all NYSSQ print material and 12 Quitline service calls. Two independent raters coded each message within these documents as being gain-framed, loss-framed or non-framed. Messages from the service calls also were coded for their function (e.g. information provision, information gathering). Interrater reliability was acceptable (kappa > 0.80). Of the 997 print messages evaluated, 21.6% were gain-framed, 13.8% were loss-framed and 64.6% were non-framed. For the service calls, only the messages with an information provision function included framed content. Of the 420 information provision messages, 10.2% were gain-framed, 1.7% were loss-framed and 88.1% were non-framed. The loss-framed and non-framed messages indicate missed opportunities for providing gain-framed messages within the Quitline services, thus emphasizing a possible gap between research and practice.

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families

Dave, J. M., Evans, A. E., Pfeiffer, K. A., Watkins, K. W., Saunders, R. P. — Tue, 04 Aug 2009 07:30:37 PDT

Availability and accessibility (AA) has been consistently shown across studies as the most important correlate of fruits and vegetables (FV) intake. However, there is little data on factors that influence AA of FV, especially in Hispanic families. The objective of this cross-sectional study was to examine the association between parental factors, child's preferences for FV and AA of FV in homes of low-income Hispanic families with children 5–12 years old. A convenience sample of 184 parents of low socioeconomic status recruited through public elementary schools completed a self-administered questionnaire about demographics, language spoken at home and food insecurity (FI). Parental factors and child's preferences were measured using a 16-item questionnaire, which was developed specifically for the study. AA of FV was measured using a validated nine-item index. Hierarchical multiple regression analysis indicated that language spoken at home, parental practices that promote consumption of FV, parental role modeling and perceived benefits of fast food had significant and independent associations with AA of FV at home. Intervention programs should take into consideration the language spoken at home and target at improving parental factors in order to improve AA of FV.

Dose relations between goal setting, theory-based correlates of goal setting and increases in physical activity during a workplace trial

Dishman, R. K., Vandenberg, R. J., Motl, R. W., Wilson, M. G., DeJoy, D. M. — Tue, 04 Aug 2009 07:30:35 PDT

The effectiveness of an intervention depends on its dose and on moderators of dose, which usually are not studied. The purpose of the study is to determine whether goal setting and theory-based moderators of goal setting had dose relations with increases in goal-related physical activity during a successful workplace intervention. A group-randomized 12-week intervention that included personal goal setting was implemented in fall 2005, with a multiracial/ethnic sample of employees at 16 geographically diverse worksites. Here, we examined dose-related variables in the cohort of participants (N = 664) from the 8 worksites randomized to the intervention. Participants in the intervention exceeded 9000 daily pedometer steps and 300 weekly minutes of moderate-to-vigorous physical activity (MVPA) during the last 6 weeks of the study, which approximated or exceeded current public health guidelines. Linear growth modeling indicated that participants who set higher goals and sustained higher levels of self-efficacy, commitment and intention about attaining their goals had greater increases in pedometer steps and MVPA. The relation between change in participants’ satisfaction with current physical activity and increases in physical activity was mediated by increases in self-set goals. The results show a dose relation of increased physical activity with changes in goal setting, satisfaction, self-efficacy, commitment and intention, consistent with goal-setting theory.

Pilot study of a cognitive intervention program for persons with multiple sclerosis

Shevil, E., Finlayson, M. — Mon, 03 Aug 2009 02:28:00 PDT

Cognitive impairments are prevalent in multiple sclerosis (MS) and can significantly limit participation in daily activities. Although the clinical depiction of cognitive impairments in MS has been well investigated, strategies to manage cognitive difficulties are less well studied. This pilot study tested a 5-week, group-based community program addressing strategies to self-manage MS cognitive changes. The goals of the program were to increase participants’ knowledge of cognitive impairments, increase levels of self-efficacy to manage cognitive difficulties and increase use of management strategies. Participants were taught various cognitive compensatory strategies and practiced their implementation between sessions. Thirty-five individuals with MS with mild-to-moderate cognitive impairments participated in the program. All participants exhibited increased knowledge of cognitive impairments and their daily impact. Participants significantly increased levels of self-efficacy in their ability to manage cognitive difficulties (₂²=37.15, P ≤ 0.0001). Self-efficacy scores were maintained at follow-up (₁²=1.48, P = 0.2230). Although the number of strategies participants used did not change significantly (₂²=2.82, P = 0.2446), they reported increased effectiveness of strategies and being able to generalize strategies to other activities. Study results point to the potential benefits of self-management programs to address cognitive symptoms in MS. Study limitations include no control group and use of non-standardized outcome measures.

Discrepancies in households and other stakeholders viewpoints on the food security experience: a gap to address

Hamelin, A.-M., Mercier, C., Bedard, A. — Mon, 29 Jun 2009 04:25:54 PDT

This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households’ perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households’ experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households’ needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.

Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents

Akre, C., Michaud, P.-A., Berchtold, A., Suris, J.-C. — Wed, 10 Jun 2009 06:32:53 PDT

The purpose of this article is to identify tobacco and cannabis co-consumptions and consumers’ perceptions of each substance. A qualitative research including 22 youths (14 males) aged 15–21 years in seven individual interviews and five focus groups. Discussions were recorded, transcribed verbatim and transferred to Atlas.ti software for narrative analysis. The main consumption mode is cannabis cigarettes which always mix cannabis and tobacco. Participants perceive cannabis much more positively than tobacco, which is considered unnatural, harmful and addictive. Future consumption forecasts thus more often exclude tobacco smoking than cannabis consumption. A substitution phenomenon often takes place between both substances. Given the co-consumption of tobacco and cannabis, in helping youths quit or decrease their consumptions, both substances should be taken into account in a global approach. Cannabis consumers should be made aware of their tobacco use while consuming cannabis and the risk of inducing nicotine addiction through cannabis use, despite the perceived disconnect between the two substances. Prevention programs should correct made-up ideas about cannabis consumption and convey a clear message about its harmful consequences. Our findings support the growing evidence which suggests that nicotine dependence and cigarette smoking may be induced by cannabis consumption.

Results from the Active for Life process evaluation: program delivery fidelity and adaptations

Thu, 26 Mar 2009 10:48:42 PDT

Active for Life® (AFL) was a large (n = 8159) translational initiative to increase physical activity (PA) in midlife and older adults. Translational research calls for a shift in emphasis from just understanding what works (efficacy) to also understanding how it works in more ‘real world’ settings. This article describes the process evaluation design and findings, discuss how these findings were used to better understand the translational process and provide a set of process evaluation recommendations with community-based translational research. AFL community organizations across the United States implemented one of two evidence-based PA programs (Active Living Every Day—The Cooper Institute; Human Kinetics Inc. or Active Choices—Stanford University). Both programs were based on the transtheoretical model and social cognitive theory. Overall, the process evaluation revealed high-dose delivery and implementation fidelity by quite varied community organizations serving diverse adult populations. Findings reveal most variation occurred for program elements requiring more participant engagement. Additionally, the results show how a collaborative process allowed the organizations to ‘fit’ the programs to their specific participant base while maintaining fidelity to essential program elements.

Psychosocial correlates of leisure-time walking among Australian adults of lower and higher socio-economic status

Janssen, E., Sugiyama, T., Winkler, E., de Vries, H., te Poel, F., Owen, N. — Mon, 23 Mar 2009 09:14:28 PDT

Adults of lower socio-economic status (SES) participate less in physical activity than those of higher SES. Understanding the correlates of physical activity participation and how these may differ between socio-economic groups can inform policies and physical activity promotion strategies. The psychosocial correlates of leisure-time walking (the most common voluntary physical activity of adults) were assessed using a survey of 2488 randomly sampled Australian adults (response rate = 74.2%). Among respondents of higher SES, there were higher levels of positive cognitions towards physical activity, and walking for leisure was more prevalent than among those of lower SES. Relationships of psychosocial attributes with leisure-time walking differed by SES. The strongest correlate of leisure-time walking was perceived barriers for lower SES adults and enjoyment for those of higher SES. Social support from friends was associated with walking for both groups, while the effect of support from family was significant only for adults of lower SES. Strategies influencing leisure-time walking may have to target the specific needs of different socio-economic groups. For example, removing perceived barriers may be more appropriate to promote walking among lower SES adults. Interventions tailored for lower SES groups may help close the socio-economic gap in physical activity participation.

Partners reducing effects of diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African-American churches

Wed, 04 Mar 2009 04:57:52 PST

Type 2 diabetes is epidemic in the United States with greater incidence rates in African-American communities. Lifestyle interventions during the phase of insulin resistance mitigate cardiovascular risk and prevent diabetes. The primary aim of this study is to test the impact of a Community Health Advisor (CHA)-based diabetes prevention controlled intervention in urban African-American communities. In this controlled trial, church congregants in New Haven, CT, receiving a 1-year CHA-led diabetes prevention intervention were compared with church congregants in Bridgeport, CT, who did not receive an intervention. Outcome measures included physical activity, dietary pattern, anthropometric measure, social support, diabetes knowledge, nutrition and exercise self-efficacy. The results indicate that at the end of the 1-year intervention period, there were no significant differences observed between intervention and control groups. Possible explanations for the lack of change include difficulty in engaging the CHAs, variability in the CHA-led interventions, baseline discrepancies between the two sites which could not be fully controlled and loss to follow-up. The results indicate important obstacles which impeded the successful implementation of this intervention and lessons learned for future interventions.

Do intervention fidelity and dose influence outcomes? Results from the Move to Improve worksite physical activity program

Fri, 23 Jan 2009 06:33:37 PST

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; ² = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

Transition in participation in sport and unstructured physical activity for rural living adolescent girls

Eime, R. M., Payne, W. R., Casey, M. M., Harvey, J. T. — Thu, 27 Nov 2008 10:12:20 PST

Physical activity (PA) is important for lifelong health; however, participation is lower in rural compared with metropolitan areas and declines during adolescence, particularly for girls. It is likely that this decline is related to the number of life transitions that occur during adolescence. This qualitative study examined the views of active rural living girls regarding the factors affecting their sport and PA participation, using the socioecological model. Twenty-seven girls aged 16–17 from four schools participated in semi-structured focus group discussions. Content and thematic analysis was conducted from verbatim transcripts using NVivo. The girls enjoyed involvement in community club sport with friends and they reported living in communities where participation in sport was a major form of social interaction. However, the desire to succeed educationally was a critical factor affecting their participation in sport and PA and influenced their movement from structured club sport to more flexible, but socially isolated individual activities. It is recommended that future longitudinal research should track rural living adolescent females as they complete secondary school, in order to better understand the influence of educational priorities upon sport and PA participation and to identify practical strategies for both schools and community organizations to foster continuing participation throughout this crucial period of life transition.

Personal, social and environmental correlates of resilience to physical inactivity among women from socio-economically disadvantaged backgrounds

Cleland, V. J., Ball, K., Salmon, J., Timperio, A. F., Crawford, D. A. — Wed, 29 Oct 2008 23:05:34 PDT

While sex and socio-economic disparities in physical activity have been well documented, not all disadvantaged women are inactive. This study aimed to examine correlates of achieving recommended levels of physical activity among women of low socio-economic position. In 2005, a population-based sample of 291 women with low educational attainment provided survey data on leisure time physical activity (LTPA). Participants reported potential personal (enjoyment and self-efficacy; barriers; intentions; guilt and priorities; routines and scheduling; occupational physical activity; television viewing), social (support from family/friends; social participation; sport/recreation club membership; dog ownership) and environmental (aesthetics; safety; local access; footpaths; interesting walks; busy roads to cross; heavy traffic) correlates of physical activity. Nearly 40% of participants achieved recommended LTPA (150 min week^–1). Multivariable analyses revealed that higher levels of self-efficacy for walking [prevalence ratio (PR) 2.05, 95% confidence interval (CI) 1.19–3.53], higher enjoyment of walking (PR 1.48, 95% CI 1.04–2.12), greater intentions to be active (PR 1.97, 95% CI 1.12–3.45) and having set routines for physical activity (PR 1.91, 95% CI 1.18–3.09) were significantly associated with achieving recommended LTPA. Personal factors were the characteristics most strongly associated with achieving recommended levels of LTPA among women from socio-economically disadvantaged backgrounds.

Application of a social cognitive model in explaining physical activity in Iranian female adolescents

Taymoori, P., Rhodes, R. E., Berry, T. R. — Mon, 20 Oct 2008 10:56:30 PDT

Adolescent Iranian girls are at high risk for physical inactivity due to cultural barriers such as restrictions regarding exercising in public and research is needed to explore ethnic and gender-related factors associated with physical activity (PA) participation. Using social cognitive theory as the guiding model, the purpose of this study was to test the fit and strength of barriers self-efficacy, outcome expectations, self-regulation and social support in explaining PA in female Iranian adolescents (n = 558). Using path analysis, social support was modeled as an antecedent of self-efficacy and outcome expectations, while self-efficacy was modeled as an antecedent of outcome expectations, self-regulatory planning and PA. Outcome expectations and self-regulatory planning were subsequently modeled as additional antecedents of PA. The model explained 52% of the variance in PA. The two significant (P < 0.05) direct effects were from self-efficacy and outcome expectations. Social support from mothers, fathers and friends had significant indirect effects on PA through self-efficacy. These results will allow for future research and interventions not only for female Iranian adolescents but also for similar cultural and immigrant groups that have been neglected to date in the PA literature.

The characteristics of the outdoor school environment associated with physical activity

Haug, E., Torsheim, T., Sallis, J. F., Samdal, O. — Mon, 20 Oct 2008 10:56:29 PDT

The school is an important setting for physical activity. The purpose of the present study was to examine the association between physical environmental characteristics and participation in daily physical activity during school breaks. Data from 130 schools and 16 471 students (Grades 4–10) in Norway were obtained in 2004 through self-administered questionnaires to principals and students. Multilevel logistic regression models revealed that boys at secondary level with a larger number of outdoor facilities at school had 2.69 times [95% confidence interval (CI) = 1.21–5.98] and girls 2.90 times (95% CI = 1.32–6.37) higher odds of being physically active compared with students in schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping rope had 2.53 times (95% CI = 1.55–4.13), with a soccer field 1.68 times (95% CI = 1.15–2.45), with playground equipment 1.66 times (95% CI = 1.16–2.37) and with a sledding hill 1.70 times (95% CI = 1.23–2.35) higher odds to be physically active compared with students in schools without these facilities. A sledding hill was also associated with girls’ physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.11–2.24). Outdoor facilities in secondary schools are associated with students’ daily physical activity participation during school breaks. Therefore, improving the outdoor environment should be considered in physical activity promotion school programs in secondary schools.

Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study

van Stralen, M. M., Lechner, L., Mudde, A. N., de Vries, H., Bolman, C. — Thu, 16 Oct 2008 12:46:44 PDT

To develop effective interventions to stimulate physical activity (PA), insight into its underlying variables is needed. The aim of this study was to obtain an overview of the most relevant determinants of awareness, initiation and maintenance of PA among the over-fifties by means of a three-round Delphi study. In the first round, 17 key-experts outlined possible relevant determinants into an open-ended electronic questionnaire. In the second round, 118 experts completed a structured electronic questionnaire that was based on the first round results, in which they scored each determinant on its relevance. In the third round, experts were asked to re-rate the relevance of each determinant, after feedback was given about the group median relevance score. After three rounds, the experts agreed on 30 relevant determinants of the three phases of PA. When compared with longitudinal studies, the Delphi study pointed out new concepts, such as several post-motivational and social and environmental determinants as possible relevant determinants, suggesting that this method has the potential to trace new and promising determinants. The results further showed that next to similarities, much dissimilarity in relevant determinants of awareness, initiation and maintenance of PA was found, suggesting that most determinants could be phase specific.

A qualitative study of parental modeling and social support for physical activity in underserved adolescents

Wright, M. S., Wilson, D. K., Griffin, S., Evans, A. — Thu, 14 Aug 2008 00:04:17 PDT

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10–14 years, 85% African-American) participated in a focus group (6–10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.

The role of collective efficacy in exercise adherence: a qualitative study of spousal support and Type 2 diabetes management

Beverly, E. A., Wray, L. A. — Mon, 16 Jun 2008 08:15:39 PDT

Adhering to increased exercise is often reported as one of the greatest challenges facing adults living with diabetes, a perception shared by the married middle-aged and older adults living with diabetes who participated in this study. Understanding how that challenge can best be met is both research and program relevant. Drawing on the social cognitive theory and social support literature, this qualitative study explored the powerful couple relationship in Type 2 diabetes management. The overarching goal of this paper was to illuminate the potentially key role of collective efficacy in exercise adherence in order to develop and test interventions that provide more effective supports for adults living with diabetes. Analyses revealed three core themes used by the couples to describe their perceived beliefs: ‘Collective support’, ‘Collective motivation’ and ‘Collective responsibility’. Our findings provide insights regarding how collective beliefs of spousal support may influence the adoption and maintenance of an exercise program. As health educators look for approaches to improve exercise adherence in diabetes management, it is important to understand how couples can be empowered to assume responsibility for their management.

Understanding children's sedentary behaviour: a qualitative study of the family home environment

Granich, J., Rosenberg, M., Knuiman, M., Timperio, A. — Thu, 22 May 2008 19:21:45 PDT

Electronic media (EM) (television, electronic games and computer) use has been associated with overweight and obesity among children. Little is known about the time spent in sedentary behaviour (SB) among children within the family context. The aim of this study was to explore how the family home environment may influence children's electronic-based SB. Focus groups and family interviews were conducted with 11- to 12-year old children (n = 54) and their parents (n = 38) using a semi-structured discussion guide. Transcripts were analysed using a thematic content approach. A brief self-completed questionnaire was also used to measure leisure behaviour and electronic devices at home. Children incorporated both sedentary and physical activities into their weekly routine. Factors influencing children's EM use included parent and sibling modelling and reinforcement, personal cognitions, the physical home environment and household EM use rules and restrictions. Participants were not concerned about the excessive time children spent with EM. This under-recognition emerged as a personal influencing factor and was viewed as a major barrier to modifying children's electronic-based SB. Efforts to reduce SB in children should focus on the influencing factors that reciprocally interact within the family home. An emphasis on increasing awareness about the risks associated with spending excessive time in screen-based activities should be a priority when developing intervention strategies aimed at modifying the time children spend in SB.