Racial–ethnic disparities in the association between risk factors and diabetes: The Northern Manhattan Study

PurposeTo identify risk factors (RF) for diabetes within a multiethnic cohort and to examine whether race–ethnicity modified their effects.MethodsParticipants in the Northern Manhattan Study without diabetes at baseline were studied from 1993 to 2014 (n = 2430). Weibull regression models with interval censoring data were fit to calculate hazard ratios and 95% confidence intervals for incident diabetes. We tested for interactions between RF and race–ethnicity.ResultsDuring a mean follow-up period of 11 years, there were 449 diagnoses of diabetes. Being non-Hispanic black (HR 1.69 95% CI 1.11–2.59) or Hispanic (HR 2.25 95% CI 1.48–3.40) versus non-Hispanic white, and body mass index (BMI; HR 1.34 per SD 95% CI 1.21–1.49) were associated with greater risk of diabetes; high-density lipoprotein cholesterol (HR 0.75 95% CI 0.66–0.86) was protective. There were interactions by race–ethnicity. In stratified models, the effects of BMI, current smoking, and C-reactive protein (CRP) on risk of diabetes differed by race–ethnicity (p for interaction < 0.05). The effects were greater among non-Hispanic whites than non-Hispanic blacks and Hispanics.ConclusionsAlthough Hispanics and non-Hispanic blacks had a greater risk of diabetes than whites, there were variations by race–ethnicity in the association of BMI, smoking, and CRP with risk of diabetes. Unique approaches should be considered to reduce diabetes as traditional RF may not be as influential in minority populations.     

Safety in numbers: Does perceived safety mediate associations between the neighborhood social environment and physical activity among women living in disadvantaged neighborhoods?

ObjectiveThe aim of this study is to examine associations between the neighborhood social environment and leisure-time physical activity (LTPA)¹ and walking among women, and whether these associations are mediated by perceived personal safety.MethodsWomen (n = 3784) living in disadvantaged urban and rural neighborhoods within Victoria, Australia completed a self-administered survey on five social environment variables (neighborhood crime, neighborhood violence, seeing others walking and exercising in the neighborhood, social trust/cohesion), perceived personal safety, and their physical activity in 2007/8. Linear regression analyses examined associations between social environment variables and LTPA and walking. Potential mediating pathways were assessed using the product-of-coefficients test. Moderated mediation by urban/rural residence was examined.ResultsEach social environment variable was positively associated with engaging in at least 150 min/week of LTPA (OR = 1.16 to 1.56). Only two social environment variables, seeing others walking (OR = 1.45) and exercising (OR = 1.31), were associated with ≥ 150 min/week of walking. Perceived personal safety mediated all associations. Stronger mediation was found in urban areas for crime, violence and social trust/cohesion.ConclusionThe neighborhood social environment is an important influence on physical activity among women living in disadvantaged areas. Feelings of personal safety should not be included in composite or aggregate scores relating to the social environment.     

Factors influencing the disconnect between self-perceived health status and actual health profile: implications for improving self-awareness of health status

ObjectiveSelf-perceived health is an often used proxy measure for disease and health behavior status. Due to its convenience in clinical and epidemiological contexts, it is of interest to examine factors that may help to explain the potential disconnect between perceived and actual health, which was the purpose of this study.MethodsData from the 2005–2006 NHANES were used (n = 1,999 adults). Perceived health status was self-reported, with the following 6 health characteristics assessed: 1) physical activity; 2) healthy eating, 3) smoking status; 4) sleep duration; 5) depression status; and 6) weight status.ResultsFor every 5 year increase in age, participants had a 7% reduced odds of having a discrepancy between perceived and actual health; Mexican Americans (vs. non-Hispanic Whites) had a 49% reduced odds of discrepancy; non-Hispanic Blacks (vs. non-Hispanic Whites) had a 40% increased odds of discrepancy, and individuals with a higher SES had a 12% increased odds of discrepancy.ConclusionTargeted public health and educational messages to young adults, non-Hispanic Blacks, and those with a higher SES may be needed to help prevent discrepancies between perceived and actual health. Preventing this disconnect may help to, for example, improve individual health awareness, and ultimately, improve health outcomes.     

Psychosocial moderators of associations between life events and changes in physical activity after leaving high school

ObjectivesTo examine 1) associations between life events and changes in leisure-time physical activity (LTPA) in school leavers and 2) whether these associations are moderated by psychosocial factors.MethodsFinal year students (n = 440) from high schools in rural Western Australia completed annual telephone interviews on three occasions; baseline (T1), one-year follow-up (T2; n = 440) and two-year follow-up (T3; n = 374). LTPA was measured using the Minnesota Leisure-time Physical Activity Questionnaire. Life events included moving out of home, working full-time and studying full-time. Psychosocial factors included enjoyment, self-efficacy, outcome expectations, club membership, and support from family and friends. Mixed linear regression models examined the effect of life events on changes in LTPA from T1 to T2 and T1 to T3.ResultsA decline in LTPA across all time points was observed. Those who continued full-time education had a smaller LTPA decline than those who did not. Those who were not a member of a sporting club at T1 had greater LTPA decline if they worked full-time at T2.ConclusionsThere is a need for interventions to prevent declines in LTPA among school leavers, especially those who do not enter tertiary education. Encouraging sporting club membership during high school might be important.     

Work,household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort

ObjectiveLarge-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study.Methods38,379 participants (62.4% women), 30–65 years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders.ResultsAfter 13.6 years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1 = 0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend = 0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1 = 0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality.ConclusionsHPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.     

Gender differences in the longitudinal associations of depressive symptoms and leisure-time physical activity with cognitive decline in ≥ 57 year-old Taiwanese

ObjectiveThis study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese.MethodWe analyzed 3679 subjects (age ≥ 57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from < 10 to ≥ 10; decreased symptoms: from ≥ 10 to < 10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores).ResultsWomen had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ² = 51.24, p < 0.001) and end-point (10.8 vs. 5.2%;χ² = 39.5, p < 0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR = 5.28, 95%CI = 2.84–9.82, p < 0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24–3.51, p = 0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19–0.65, p = 0.001) and women with increased LTPA had 43% (0.57, 0.34–0.93, p = 0.024) reduction in odds of developing cognitive decline.ConclusionWe found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging.     

Does the fat-but-fit paradigm hold true for all-cause mortality when considering the duration of overweight/obesity? Analyzing the WATCH (Weight,Activity and Time Contributes to Health) paradigm

BackgroundPhysical activity has been shown to attenuate the association between overweight/obesity and mortality. Much less is known, however, on how the duration of overweight/obesity potentially alters this association, which was the purpose of this study.MethodsThe 1999–2006 NHANES was used and 11,057 adults (ages 36–85) were evaluated. Eight mutually exclusive groups were created: (1) physically active, normal weight now and 10 years ago; (2) physically inactive, normal weight now and 10 years ago; (3) physically active, overweight/obese now but normal weight 10 years ago; (4) physically inactive, normal weight now but overweight/obese 10 years ago; (5) physically active, overweight/obese now but normal weight 10 years ago; (6) physically inactive, overweight/obese now but normal weight 10 years ago; (7) physically active, overweight/obese now and 10 years ago; and (8) physically inactive, overweight/obese now and 10 years ago.ResultsAfter adjustments, only those individuals that were inactive were at a significantly increased risk for all-cause mortality independent of overweight/obesity status (Groups 2, 4, 6, 8).ConclusionIn alignment with the Exercise is Medicine initiative®, our results provide support for clinicians to perform routine assessments of physical activity, and to further promote physical activity among all individuals regardless of body mass status.     

Tobacco use disparities by racial/ethnic groups: California compared to the United States

Racial/ethnic disparities in cigarette use and cessation persist. This study compared cigarette consumption and former smoking trends in California (CA) with the rest of the United States (US) by racial/ethnic categories of non-Hispanic White, Black, Hispanic/Latino, and Asian/Pacific Islander groups. Data were analyzed from the 1992 to 2011 Tobacco Use Supplement to the Current Population Survey. Consumption levels across decades were examined and adjusted logistic regression models were fit to compare across CA and US.Results indicated steady declines in ever smoking prevalence for all groups with much lower magnitudes of change among US Blacks and Whites compared to their CA counterparts. After controlling for age, gender, and education, CA had significantly fewer heavy smokers (OR = 0.45, 95% CI:0.38–0.54), more light and intermittent smokers (LITS; OR = 1.68, 95%CI: 1.45–1.93), and a greater proportion of former smokers (OR = 1.35, 95%CI: 1.24–1.48) than the rest of US. Data were stratified by race/ethnicity and the patterns shown were mostly consistent with CA performing statistically better than their US counterparts with the exception of Black LITS and Asian/Pacific Islander former smokers. California's success in reducing tobacco use disparities may serve as a prime example of tobacco control policy for the country. CA and the US will need to continue to address tobacco use and cessation in the context of the growing diversity of the population.     

Human papillomavirus vaccine series completion in boys before and after recommendation for routine immunization

BackgroundAlthough the incidence of HPV-attributable cancers in males is rapidly increasing, HPV vaccine uptake in males remains poor. While quadrivalent human papillomavirus vaccine (4vHPV) series initiation in males increased following the Advisory Committee Immunization Practices (ACIP) male routine use recommendation, its impact on 4vHPV series completion in males at ACIP-recommended intervals has not been evaluated in large male cohorts. We examined trends and correlates of 4vHPV completion since licensure in males in a large cohort of insured boys before and after the ACIP routine use recommendation.MethodsWe grouped data from electronic medical records of males aged 9–17 years from Kaiser Permanente Southern California health plan who initiated 4vHPV into 3 cohorts by 4vHPV initiation date: licensure and ACIP permissive use: 2009–2010; addition of anal cancer indication: 2010–2011; ACIP routine use: 2011–2013. We estimated adjusted hazard ratios (AHRs) between patient and provider characteristics and vaccination using Marginal Cox proportional hazards models.ResultsOf 80,800 boys initiating 4vHPV, 24.3% completed the series within 12 months with minimal differences across cohorts. Completion decreased with increasing age at initiation (13–17 vs. 11–12 year olds: AHR = 0.85; 95% confidence interval [CI] = 0.80, 0.89) and was greater among patients with a primary care provider (AHR = 1.28, 95%CI = 1.17, 1.41), influenza vaccine recipients (AHR = 1.50, 95% CI = 1.43, 1.57), and Asian/Pacific Islanders (AHR = 1.07, 95% CI = 1.00, 1.15), and lower among non-Hispanic Blacks (AHR = 0.72, 95% CI = 0.65, 0.80) and Hispanics (AHR = 0.86, 95% CI = 0.81, 0.90) compared to non-Hispanic Whites.ConclusionsDespite the ACIP routine use recommendation in males, 4vHPV series completion remained low. 4vHPV initiation at 11–12 years and identification of a provider responsible for the adolescents’ health care may increase 4vHPV series completion. Given the rapidly increasing incidence of HPV-related cancers in males, it is important to identify measures to increase HPV vaccine series completion, particularly among non-Hispanic Black and Hispanic males.     

Independent and joint associations of race/ethnicity and educational attainment with sleep-related symptoms in a population-based US sample

ObjectivePrior studies have documented disparities in short and long sleep duration, excessive daytime sleepiness, and insomnia by educational attainment and race/ethnicity separately. We examined both independent and interactive effects of these factors with a broader range of sleep indicators in a racially/ethnically diverse sample.MethodsWe analyzed 2012 National Health Interview Survey data from 33,865 adults aged ≥ 18 years. Sleep-related symptomatology included short sleep duration (≤ 6 h), long sleep duration (≥ 9 h), fatigue > 3 days, excessive daytime sleepiness, and insomnia. Bivariate analyses with chi-square tests and log-linear regression were performed.ResultsThe overall age-adjusted prevalence was 29.1% for short sleep duration, 8.5% for long sleep duration, 15.1% for fatigue, 12.6% for excessive daytime sleepiness, and 18.8% for insomnia. Educational attainment and race/ethnicity were independently related to the five sleep-related symptoms. Among Whites, the likelihood of most sleep indicators increased as educational attainment decreased; relationships varied for the other racial/ethnic groups. For short sleep duration, the educational attainment-by-race/ethnicity interaction effect was significant for African Americans (p < 0.0001), Hispanics (p < 0.0001), and Asians (p = 0.0233) compared to Whites. For long sleep duration, the interaction was significant for Hispanics only (p = 0.0003).ConclusionsOur results demonstrate the importance of examining both educational attainment and race/ethnicity simultaneously to more fully understand disparities in sleep health. Increased understanding of the mechanisms linking sociodemographic factors to sleep health is needed to determine whether policies and programs to increase educational attainment may also reduce these disparities within an increasingly diverse population.     

Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes

ObjectiveInvestigate levels of physical activity and their association with health in a white European (WE) and South Asian (SA) population.MethodsThis study reports data from a diabetes screening programme, 2004–2007, Leicester, UK. Physical activity was measured using the International Physical Activity Questionnaire; additional outcomes included fasting and 2-h post-challenge glucose, lipid profile, body mass index (BMI) and waist circumference.Results1164 SA (female = 48%) and 4310 WE (female = 53%) were included. SAs were more likely fall below the minimum physical activity recommendations for health compared to WEs (age-adjusted OR for SA men = 2.35; 95% CI = 1.89–2.93, age adjusted OR for SA women = 2.25; 95% CI = 1.81–2.80). There were significant associations between levels of physical activity and BMI (men and women), waist circumference (men and women), 2-h glucose (women), HDL-cholesterol (men) and triglycerides (men) in WEs and waist circumference (women) and HDL-cholesterol (men) in SAs. Significant interactions between ethnicity and physical activity existed in the relationship with BMI and waist circumference in men.ConclusionsSAs are substantially less physically active than WEs. There may also be differences between SAs and WEs in the health benefits associated with higher physical activity that warrant further investigation.     

The association of C-reactive protein and physical activity among a church-based population of African Americans

ObjectiveRegular physical activity can reduce systemic inflammation and, thereby, the burden of chronic inflammatory-related conditions. This study examined whether regular physical activity, measured subjectively (Rapid Assessment of Physical Activity [RAPA]) and objectively (Bodymedia's SenseWear® activity monitor [SWA]), is associated with inflammatory or glycemic control markers.MethodsSubjects were 345 participants of the Healthy Eating and Active Living in the Spirit (HEALS) lifestyle intervention among African American (AA) churches in South Carolina from 2009 to 2012. Linear regression analyses were performed to assess the relationship between both subjectively and objectively measured physical activity and inflammatory markers including high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), and glycosylated hemoglobin (HbA1c).ResultsThose who participated in regular physical activity (from RAPA) had lower CRP values compared to those who were sedentary (2.3 vs. 3.8 mg/L, p < 0.01). Lower levels of CRP or IL-6 were observed among those in the highest quartile of active energy expenditure (CRP: 2.0 vs. 3.6 mg/L, p = 0.01) or moderate–vigorous physical activity minutes (CRP = 1.7 vs. 4.5 mg/L, p < 0.01; IL-6 = 1.5 vs. 2.1 pg/mL, p = 0.01) compared to their lowest respective quartiles as measured by the SWA.ConclusionPhysical activity may improve chronic inflammation, which is a primary pathophysiological mechanism for numerous chronic disorders, especially among minority populations.     

Perceived racial/ethnic discrimination,smoking and alcohol consumption in the Multi-Ethnic Study of Atherosclerosis (MESA)

ObjectiveTo examine the association of perceived racial/ethnic discrimination with smoking and alcohol consumption in adults participating in the Multi-Ethnic Study of Atherosclerosis.MethodsData on 6680 black, Chinese, Hispanic and white adults aged 45 to 84 years of age recruited from Illinois, New York, Maryland, North Carolina, Minnesota and California during 2000 and 2002 were used for this analysis. Logistic regression was used to estimate the association of perceived racial/ethnic discrimination with smoking status and alcohol consumption for each racial/ethnic group separately.ResultsBlacks were more likely to experience racial/ethnic discrimination (43%) than Hispanics (19%), Chinese participants (10%) or whites (4%, P < 0.0001). In the fully-adjusted model, blacks reporting racial/ethnic discrimination had 34% and 51% greater odds of reporting smoking and drinking, respectively, than blacks who did not report racial/ethnic discrimination. Hispanics reporting racial/ethnic discrimination had 62% greater odds of heavy drinking. Whites reporting racial/ethnic discrimination had 88% greater odds of reporting being current smokers than whites who did not report racial/ethnic discrimination.ConclusionsOur findings suggest that the experience of discrimination is associated with greater prevalence of unhealthy behaviors. Specifically, the use of smoking and alcohol may be patterned by experience of discrimination.     

Levels of physical activity among adults 18–64 years old in 28 European countries

BackgroundSedentary lifestyle is associated with more than three million deaths annually. Data from the 2013 Eurobarometer survey were analyzed to assess levels of physical activity across the European Union (EU) and to explore factors associated with adequate and high physical activity.MethodsA representative sample of n = 19,978 individuals aged 18–64 years from the 28 EU countries (sub-sample of the Eurobarometer survey, wave 80.2) was analyzed. Frequency and average duration of walking, moderate and vigorous physical activity was assessed with a self-reported questionnaire. Participants were then classified as physically inactive or adequately/highly active, based on the World Health Organization's (WHO) recommendations. The total amount of MET-minutes (MET-min) per week was also calculated for each respondent.ResultsThe proportion of physically inactive individuals was 28.6%, (12.4% in Sweden to 53.7% in Cyprus), while 59.1% of the respondents (37.9% in Portugal and Cyprus to 72.2% in Sweden) were classified as highly active. The mean total weekly physical activity was 2151 MET-min (95%CI: 2095–2206), of which 891 MET-min (95%CI: 858–924) were contributed by vigorous exercise, 559 MET-min (95%CI: 540–578) by moderate exercise (excluding walking) and 690 MET-min (95%CI: 673–706) by walking. Male gender, younger age, residence in rural areas and Northern Europe, higher education level and ability to pay bills were independently associated with higher physical activity.ConclusionOne fourth of the EU population did not meet the WHO's recommendations for physical activity, with wide inequalities between and within countries. Wide-reaching environmental approaches are required to promote physical activity and address these inequalities.     

Effects of physical activity on schoolchildren's academic performance: The Active Smarter Kids (ASK) cluster-randomized controlled trial

ObjectiveTo investigate the effect of a seven-month, school-based cluster-randomized controlled trial on academic performance in 10-year-old children.MethodsIn total, 1129 fifth-grade children from 57 elementary schools in Sogn og Fjordane County, Norway, were cluster-randomized by school either to the intervention group or to the control group. The children in the 28 intervention schools participated in a physical activity intervention between November 2014 and June 2015 consisting of three components: 1) 90 min/week of physically active educational lessons mainly carried out in the school playground; 2) 5 min/day of physical activity breaks during classroom lessons; 3) 10 min/day physical activity homework. Academic performance in numeracy, reading and English was measured using standardized Norwegian national tests. Physical activity was measured objectively by accelerometry.ResultsWe found no effect of the intervention on academic performance in primary analyses (standardized difference 0.01–0.06, p > 0.358). Subgroup analyses, however, revealed a favorable intervention effect for those who performed the poorest at baseline (lowest tertile) for numeracy (p = 0.005 for the subgroup 1 group interaction), compared to controls (standardized difference 0.62, 95% CI 0.19–1.07).ConclusionsThis large, rigorously conducted cluster RCT in 10-year-old children supports the notion that there is still inadequate evidence to conclude that increased physical activity in school enhances academic achievement in all children. Still, combining physical activity and learning seems a viable model to stimulate learning in those academically weakest schoolchildren.     

Moderators of health behavior initiation and maintenance in a randomized telephone counseling trial

ObjectiveThis study compares moderators of initiation and maintenance of health behavior changes.MethodsData come from a cluster-randomized, 12-month telephone counseling intervention for physical activity and diet, targeting type 2 diabetes or hypertension patients (n = 434, Australia,2005–2007). Demographic and health-related characteristics, theoretical constructs, and baseline behavioral outcomes were considered as moderators. Mixed models, adjusting for baseline values, assessed moderation of intervention effects for trial outcomes (physical activity, intakes of fat, saturated fat, fiber, fruit, vegetables) at end-of-intervention (12 months/initiation) and maintenance follow-up (18 months), and compared moderation between these periods.ResultsSocial support for physical activity and baseline physical activity were significant (p < 0.05) moderators of physical activity at 12 months. Gender, marital status, social support for healthy eating, BMI, and number of chronic conditions were significant moderators of dietary changes at 12- and/or 18 months. Instances of moderation differing significantly between 12- and 18 months were: baseline physical activity for physical activity (initiation) and marital status for fat intake (maintenance).ConclusionsThis exploratory study showed that moderation of physical activity and diet effects sometimes differed between initiation and maintenance. To identify unique moderators for initiation and/or maintenance of behavior changes, future studies need to report on and statistically test for such differences.     

Prospective effects of pedometer use and class competitions on physical activity in youth: A cluster-randomized controlled trial

ObjectiveTo evaluate the immediate effects of a school-based multi-component program to foster a physically active lifestyle in adolescence.Design/participantsIn a cluster-randomized controlled trial with pre- and post-assessment in 2014, 29 schools with 1162 8th grade students (48% girls) from Germany were included. Age ranged from 12 to 17 years (M = 13.74; SD = 0.67).InterventionWhile the control group attended education as usual, students in the intervention group received pedometers and took part in a class competition over a time period of 12 weeks. Classes with the most steps and best creative ideas to promote physical activity in everyday life were awarded.Main outcome measuresPrimary outcomes included out-of-school sports activities (h/week), moderate to vigorous physical activity (days/week with a minimum of 60 min), active commuting (min/day), doing chores (min/day), and sedentary behavior (h/day) assessed through self-administered questionnaires as well as cardiorespiratory fitness measured using the 20-m shuttle-run test (completed laps).ResultsSignificant interaction terms between group and wave of assessment were found on out-of-school sports activities (b = − 1.09 [− 1.89; − 0.29], p = 0.008), moderate to vigorous physical activity (b = − 0.29 [− 0.47; − 0.10], p = 0.002), and active commuting (b = − 20.41 [− 32.32; − 8.49], p = 0.001): students in the intervention group showed a higher increase of physical activity levels than students in the control group. The intervention effect on cardiorespiratory fitness missed significance marginally (b = − 1.52 [− 3.14; 0.98], p = 0.065), There was no effect on students' sedentary behavior (b = 0.06 [− 0.72; 0.84], p = 0.881).ConclusionsAn easy to administer school-based physical activity program (12 weeks) may enhance students' leisure-time physical activity.Trial registration number: ISRCTN49482118     

Eleven-year physical activity trends in a Swiss urban area

ObjectiveRegular physical activity is a major health determinant. Little is known about physical activity trends. We evaluated whether adult physical activity levels are changing in a Swiss urban state (Geneva).MethodWe analyzed 11-year trends of physical activity indicators, including 3+ MET-minutes per week and physical activity outside working hours, in population representative adults (n = 9320, aged 35–74 years, 50% women), relating declared physical activity to socioeconomic status, lifestyle, and clinical and blood markers.ResultsCombining yearly cohorts from 1999 to 2009, we found a significant trend for increased physical activity levels. Weekly age and sex adjusted 3+ MET-minutes per week increased from 3023 to 3752, between 1999 and 2009 (P = 0.02). The increase also concerned physical activity outside working hours (+ 18 kcal/day/year). There was a shift from low levels of physical activity levels towards higher activities. Physical activity indicators were associated with socioeconomic status, comorbidities, and biological and anthropometric measures. The trend for increased physical activity was more prominent over the latter 5 years.ConclusionWe found that physical activity levels have increased in an urban Swiss state. The increase is significant but small, and further efforts to promote physical activity are therefore warranted.     

Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior

ObjectiveTo investigate the relation of classroom physical activity breaks to students' physical activity and classroom behavior.MethodsSix elementary-school districts in California implemented classroom physical activity interventions in 2013–2014. Students' (N = 1322) accelerometer-measured moderate-to-vigorous physical activity (MVPA) during school and teachers' (N = 397) reports of implementation and classroom behavior were assessed in 24 schools at two time points (both post-intervention). Mixed-effects models accounted for nested data.ResultsMinutes/day of activity breaks was positively associated with students' MVPA (βs = .07–.14; ps = .012–.016). Students in classrooms with activity breaks were more likely to obtain 30 min/day of MVPA during school (OR = 1.75; p = .002). Implementation was negatively associated with students having a lack of effort in class (β = − .17; p = .042), and student MVPA was negatively associated with students being off task or inattentive in the classroom (β = − .17; p = .042). Students provided with 3–4 physical activity opportunities (classroom breaks, recess, PE, dedicated PE teacher) had ≈ 5 more min/day of school MVPA than students with no opportunities (B = 1.53 min/opportunity; p = .002).ConclusionsImplementing classroom physical activity breaks can improve student physical activity during school and behavior in the classroom. Comprehensive school physical activity programs that include classroom-based activity are likely needed to meet the 30 min/day school physical activity guideline.     

Influence of provider discussion and specific recommendation on colorectal cancer screening uptake among U.S. adults

ObjectivesIt is unclear if provider recommendations regarding colorectal cancer (CRC) screening modalities affect patient compliance. We evaluated provider–patient communications about CRC screening with and without a specific screening modality recommendation on patient compliance with screening guidelines.MethodsWe used the 2007 Health Information National Trends Survey (HINTS) and identified 4283 respondents who were at least 50 years of age and answered questions about their communication with their care providers and CRC screening uptake. We defined being compliant with CRC screening as the use of fecal occult blood testing (FOBT) within 1 year, sigmoidoscopy within 5 years, or colonoscopy within 10 years. We used survey weights in all analyses.ResultsCRC screening discussions occurred with 3320 (76.2%) respondents. Approximately 95% of these discussions were with physicians. Overall, 2793 (62.6%) respondents were current with CRC screening regardless of the screening modality. Discussion about screening (odds ratio (OR) = 8.83; 95% confidence interval (CI): 7.20–10.84) and providers making a specific recommendation about screening modality rather than leaving it to the patient to decide (OR = 2.04; 95% CI: 1.54–2.68) were associated with patient compliance with CRC screening guidelines.ConclusionCompliance with CRC screening guidelines is improved when providers discuss options and make specific screening test recommendations.