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.     

The association between discrepant weight perceptions and objectively measured physical activity

BackgroundSome individuals perceive themselves as being normal weight, despite having an excess body fat percentage (e.g., underestimate weight). Conversely, other individuals perceive themselves as being overweight, despite having a normal body fat percentage (e.g., overestimate weight). When perceived and actual weight statuses are incongruent, individuals possess a discrepant weight perception. The association between discrepant weight perceptions and engagement in moderate-to-vigorous physical activity (MVPA) has not been thoroughly investigated, which was this study's purpose.MethodsFor this cross-sectional study, data from the 2003–2006 National Health and Nutrition Examination Survey were utilized (N = 5462 adults). MVPA was assessed via accelerometry. Based on measured body mass index and whether participants considered themselves as overweight, underweight, or about the right weight, we classified individuals as accurate perception, overestimate weight (discrepant), or underestimate weight (discrepant). A negative binomial logistical regression was used to assess the association between discrepant weight perception (independent variable) and engagement in MVPA (outcome variable).ResultsFemales who said that they are normal weight, but were in fact overweight based on body mass index, engaged in 13% less MVPA (rate ratio = .87, 95% confidence interval: .769–.999, P = .05). Also, older adults (> 60 yrs) who said that they are normal weight, but were overweight based on body mass index, engaged in 23% less MVPA (rate ratio = .77, 95% confidence interval: .616–.965, P = .025).ConclusionDiscrepant weight perceptions were associated with less objectively measured MVPA. Interventions should take weight perceptions into consideration when designing and evaluating intervention impact.     

Urinary phthalate metabolite concentrations and blood glucose levels during pregnancy

PurposeTo examine associations between phthalate metabolite urinary concentrations during early pregnancy and blood glucose levels obtained at the time of screening for gestational diabetes mellitus (GDM).MethodsUpon initiation of prenatal care, women with a mean gestational age of 12.8 weeks were recruited for a study of environmental chemical exposures (n = 110) and provided a spot urinary specimen. Blood glucose concentrations (mg/dl) were obtained from the electronic medical record for those patients who did not experience a pregnancy loss and did not transfer care to another facility prior to glucose screening (n = 72). Urinary concentrations of nine phthalate metabolites and creatinine were measured at the US Centers for Disease Control and Prevention. Associations between tertiles of phthalate metabolites concentrations and blood glucose levels were estimated using linear regression.ResultsCompared to pregnant women in the lowest concentration tertile, women with the highest urinary concentrations (≥3rd tertile) of mono-iso-butyl phthalate (tertile: ≥15.3 μg/l, β = −18.3, 95% CI: −35.4, −1.2) and monobenzyl phthalate (tertile: ≥30.3 μg/l, β = −17.3, 95% CI: −34.1, −0.4) had lower blood glucose levels at the time of GDM screening after adjustment for urinary creatinine and demographic covariates.ConclusionBecause maternal glucose levels increase during pregnancy to provide adequate nutrition for fetal growth and development, these findings may have implications for fetal health. However, given the limitations of our study, findings should be interpreted cautiously.     

Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes

Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8 km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004–2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.     

Is there an association between the coverage of immunisation boosters by the age of 5 and deprivation? An ecological study

ObjectiveTo determine whether there was an association between the coverage of booster immunisation of Diphtheria, Tetanus, acellular Pertussis and Polio (DTaP/IPV) and second Measles, Mumps and Rubella (MMR) dose by age 5 in accordance with the English national immunisation schedule by area-level socioeconomic deprivation and whether this changed between 2007/08 and 2010/11.DesignEcological study.DataRoutinely collected national Cover of Vaccination Evaluated Rapidly data on immunisation coverage for DTaP/IPV booster and second MMR dose by age 5 and the Index of Multiple Deprivation (IMD).SettingPrimary Care Trust (PCT) areas in England between 2007/08 and 2010/11.Outcome MeasuresPopulation coverage (%) of DTaP/IPV booster and second MMR immunisation by age 5.ResultsOver the 4 years among the 9,457,600 children there was an increase in the mean proportion of children being immunised for DTaP/IPV booster and second MMR across England, increasing from 79% (standard deviation (SD12%)) to 86% (SD8%) for DTaP/IPV and 75% (SD10%) to 84% (SD6%) for second MMR between 2007/08 and 2010/11. In 2007/08 the area with lowest DTaP/IPV booster coverage was 31% compared to 54.4% in 2010/11 and for the second MMR in 2007/08 was 39% compared to 64.8% in 2010/11. A weak negative correlation was observed between average IMD score and immunisation coverage for the DTaP/IPV booster which reduced but remained statistically significant over the study period (r = −0.298, p < 0.001 in 2007/08 and r = −0.179, p = 0.028 in 2010/11). This was similar for the second MMR in 2007/08 (r = −0.225, p = 0.008) and 2008/09 (r = −0.216, p = 0.008) but there was no statistically significant correlation in 2009/10 (r = −0.108, p = 0.186) or 2010/11 (r = −0.078, p = 0.343).ConclusionLower immunisation coverage of DTaP/IPV booster and second MMR dose was associated with higher area-level socioeconomic deprivation, although this inequality reduced between 2007/08 and 2010/11 as proportions of children being immunised increased at PCT level, particularly for the most deprived areas. However, coverage is still below the World Health Organisation recommended 95% threshold for Europe.     

Risk perceptions,sexual attitudes,and sexual behavior after HPV vaccination in 11–12 year-old girls

ObjectivesAmong 11–12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls’ risk perceptions, attitudes, and behavior.MethodsGirls and mothers (n = 25 dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls’ 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis.ResultsGirls’ baseline knowledge was poor but often improved with time. Most girls (n = 18) developed accurate risk perceptions about HPV but only half (n = 12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions.ConclusionsHigher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.     

Weight control success and depression by gender with respect to weight control behaviors

Background/ObjectiveThere are many methods for weight loss and they vary among people. Some are yet to be proven as appropriate regarding its physical or mental side effect. The aim of this study was to investigate the relationship between weight control success and depression by weight control behaviors (WCB) dividing them into appropriate and inappropriate.Subjects/MethodsWe used data from the 2016 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 4506 people were included in the study. The depression was measured by the 9-item Patient Health Questionnaire as a dependent variable. Using multiple regression analysis to determine the association between weight control success and depression with appropriate and inappropriate WCB, in men and women, separately.ResultsWe found that appropriate WCB was associated with decreased depression in women who had both success and fail (success: β = −0.16, S.E = 0.50, p < .001; fail: β = −0.09, S.E = 0.04, p = 0.04), whereas inappropriate WCB increased depression in men regardless of success or failure at weight control (success: β = 0.41, p = 0.02; fail: β = 0.22, p = 0.02). Thus, women who are successful at weight control and use appropriate WCB are more likely to have a decrease in depressive symptoms. However, men are most affected by using inappropriate WCB and can have an increase in depressive symptoms as a result.ConclusionThe findings have implications for encouraging the use of appropriate WCB for those attempting to control weight, especially in women.     

Neighborhood socioeconomic status in relation to dietary intake and body mass index in female Japanese dietetic students

ObjectiveAn increasing number of studies conducted in Western countries have shown that living in a socioeconomically disadvantaged neighborhood is associated with unfavorable dietary intake patterns and an unfavorable health status. However, information on such neighborhood socioeconomic differences in diet and health among different cultural settings, including Japan, is absolutely lacking. This cross-sectional study examined the association of neighborhood socioeconomic status (SES) with dietary intake and body mass index (BMI) in a group of young Japanese women.MethodsSubjects were 3892 female Japanese dietetic students 18–20 y of age from 53 institutions, residing in 1033 municipalities in 47 prefectures in Japan. Neighborhood SES index was defined by seven municipal-level variables, namely unemployment, household overcrowding, poverty, education, income, home ownership, and vulnerable groups, with an increasing index signifying increasing neighborhood socioeconomic disadvantage. Dietary intake was estimated using a validated, comprehensive self-administered diet history questionnaire. BMI was computed from self-reported body weight and height.ResultsNeighborhood SES index was not materially associated with most of the dietary variables. However, neighborhood SES index was positively associated with BMI, with significance (P for trend = 0.020). This significant association remained after adjustment for potential confounding or mediating factors including household SES, dietary, other lifestyle, and geographic factors (P for trend = 0.037).ConclusionAlthough no material association was seen between neighborhood SES and dietary intake, increasing neighborhood socioeconomic disadvantage was independently associated with increasing BMI in a group of young Japanese women.     

E-health. Patterns of use and perceived benefits and barriers among people living with HIV and their physicians. Part 1: Information retrieval on the Internet and social networks

ObjectivesTo identify patterns of use, perceived benefits, and barriers among people living with HIV (PLHIV) of online searches for health information and via social media.MethodsOnline multicentre observational survey (October 15th–19th, 2018).ResultsStudy participation was accepted by 838/1377 PLHIV followed in 46 centres, of which 325 (39%) responded online: 181 (56%) had already used the Internet to search for health information; 88/181 (49%) on HIV infection and 78 (43%) on nutrition. These 56% were characterised by a higher educational level (OR = 1.82 ± 0.50; P = 0.028) and more often consulted other specialists (OR = 3.14 ± 1.26; P = 0.004). A subset of 87/180 (48%) PLHIV had changed the way they looked after their health based on their online research, and were more often in material/social deprivation (P = 0.02) and diabetic (P = 0.02). A small subset of 19/180 (11%) had already asked or answered a question on a forum; these people tended to be women (P = 0.03) in material/social deprivation (P = 0.009). 296/322 (92%) PLHIV trusted their physician whereas only 206 (64%) trusted information sourced on medical websites. 238/323 (74%) PLHIV expected their physicians to recommend websites if asked, whereas only 23/323 (7%) had actually been given this guidance.ConclusionMore than half of PLHIV surveyed had already searched for health information on the Internet, and one in two had changed their behaviour based on the online search. PLHIV did not see the Internet as an alternative to physicians but they wanted their physicians to guide them on how to find quality health information to better self-manage their condition.     

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.     

Serum uric acid as a predictor of future hypertension: Stratified analysis based on body mass index and age

BackgroundSerum uric acid level is a predictor of future hypertension. However, its dependence on body mass index or age is unclear.MethodsWe examined 26,442 Japanese males aged 18–60 years free from hypertension or diagnosed cardiovascular disease at baseline followed up between 2000 and 2010. Participants were categorized into three groups according to the tertile of serum uric acid levels [mg/dL; 1st (reference): 0.1–5.3; 2nd: 5.4–6.2; 3rd: 6.3–11.6]. Incident hypertension was defined as newly detected blood pressure ≥ 140/90 mm Hg and/or antihypertensive drugs initiation. Body mass index (< 25 kg/m² vs. ≥ 25 kg/m²) and age (< 40 years vs. ≥ 40 years) were stratified into two groups.ResultsDuring a mean follow-up of 7.2 years, there were 11,361 (43%) hypertension cases. Mean serum uric acid levels (mg/dL) at baseline in each group were 1st tertile, 4.6; 2nd tertile, 5.8; and 3rd tertile, 7.0. The cumulative incident hypertension rate was significantly higher in the 3rd tertile (50.8%) than in the 1st (37.4%). Multiple-adjusted hazard ratios (95% confidence interval) for incident hypertension compared with 1st tertile were 1.01 (0.96–1.05) and 1.15 (1.10–1.21) in the 2nd and 3rd tertile, respectively. There was a significant interaction between age and serum uric acid level (p for interaction = 0.035). In subjects aged ≥ 40 years, the 3rd serum uric acid group showed higher hazard ratios [1.48 (1.38–1.59)].ConclusionHigh serum uric acid level was associated with future hypertension in young and middle-aged Japanese males. This association was stronger among subjects ≥ 40 years old.     

Crime and perceptions of safety in the home neighborhood are independently associated with physical activity among 11–15 year olds

ObjectiveTo determine whether perceptions of neighborhood safety and measures of neighborhood crime are independently associated within physical activity in youth.MethodsThe study sample consisted of 14,125 youths in grades 6–10 (ages 11–15) who participated in the nationally representative cross-sectional 2009/10 Canadian Health Behaviour in School-Aged Children Survey. Participants responded to four questions about how safe their home neighborhood is and reported whether or not they accumulated at least 4 h/week of physical activity in their free-time outside of school hours. Crimes against persons was assessed in 1 km radius buffers around participants' homes. Associations were assessed using logistic regression.ResultsAfter controlling for crime and relevant confounders, the relative odds of being physically active outside of school was 0.52 (95% CI: 0.44–0.62) in youth whose perceptions of neighborhood safety were in the lowest quintile. After controlling for perceptions of safety and relevant confounders, the relative odds of being physically active outside of school was 0.75 (0.60–0.95) in youth from neighborhoods with crimes against persons scores in the highest quintile.ConclusionsWithin this large sample of 11–15 year olds, perceptions and objective measures of neighborhood safety and crime were independently associated with physical activity in free-time outside of school.     

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments.Study designObservational, cross-sectional survey.LocationPrimary Care Teaching Unit. Madrid.ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed.Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy.ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r =  −0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians’ self-perceived empathy and their patients’ perceptions.ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.     

A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults

ObjectiveThe present review examines efficacious psycho-behavioral interventions in preventing weight gains or reducing weight among US multiethnic and minority adults as few studies were conducted to review such interventions to date.MethodsData were examined from 24 controlled intervention studies, representing 23 programs and involving 13,326 adults. Studies were identified through manual and online search of databases that include MEDLINE, Academic Search Premier, ERIC, PsycARTICLES, SPORTDiscus, and CINAHL Plus.ResultsWhereas one-component (n = 5, d = 0.08, 90% CI = − 0.04, 0.35) and two-component interventions (n = 13, d = 0.22, 90% CI = 0.05, 0.40) showed a low mean effect size, three-component interventions (n = 6, d = 0.52, 90% CI = 0.39, 0.65) showed a moderate effect size. Interventions conducted in individual sessions (n = 15, d = 0.40, 90% CI = 0.24, 0.56) showed a higher mean effect size than group interventions (n = 9, d = 0.08, 90% CI = − 0.04, 0.30) although the confidence intervals overlapped.ConclusionsThe study results indicate that future obesity prevention interventions targeting multiethnic and minority adults might benefit from incorporating individual sessions, family involvement, and problem solving strategies into multi-component programs that focus on lifestyle changes.     

The ‘Healthy Dads,Healthy Kids’ community randomized controlled trial: A community-based healthy lifestyle program for fathers and their children

ObjectiveTo evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids (HDHK)’ program when delivered by trained facilitators in community settings.MethodA two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age = 40.3 [5.3] years; BMI = 32.5 [3.8] kg/m²) and their primary school-aged children (n = 132) from the Hunter Region, Australia. In 2010–2011, families were randomized to either: (i) HDHK intervention (n = 48 fathers, n = 72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors.ResultsLinear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d = 0.24), with HDHK fathers losing more weight (− 3.3 kg; 95%CI, − 4.3, − 2.4) than control fathers (0.1 kg; 95%CI, − 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d = 0.41), BMI (d = 0.26), resting heart rate (d = 0.59), energy intake (d = 0.49) and physical activity (d = 0.46) and for children's physical activity (d = 0.50) and adiposity (d = 0.07).DiscussionHDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.     

General practitioners’ attitudes and behaviors toward HPV vaccination: A French national survey

ObjectiveGeneral practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations.MethodsCross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general.ResultsOverall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R² = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R² = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R² = 0.03).ConclusionAlthough nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.     

COVID- 19 outbreak: Does confinement have any impact on weight change perception?

PurposeThis study aimed to evaluate the relationship between factors related to COVID-19 confinement (i.e., fear of COVID-19, anxiety, anger, boredom, eating disorders, and duration of confinement) and weight perception in a sample of the Lebanese population.MethodsA cross-sectional web-based survey carried out at a one-time point between April 3 and 18, 2020, enrolled 407 participants. Due to the imposed lockdown, respondents self-reported their weight and height. One dichotomized question (positive/negative) assessed the perception of weight change (yes = change perception, and no = no change perception). The variation in BMI was calculated by subtracting the estimated weight during confinement from the estimated weight before.ResultsNo significant variation in BMI was detected before and during the confinement (p = 0.40), while a perceived weight change was found in 212 (52.1%) participants. The regression analysis showed that higher fear of COVID-19 score (ORa = 0.96) and higher self-reported weight change (ORa = 0.47) were associated with lower weight change perception. However, longer confinement duration (ORa = 1.07), higher anxiety (ORa = 1.05), and high eating concerns (ORa = 1.81) were associated with higher weight change perception.ConclusionOur results revealed that both the fear of COVID-19 and self-reported weight change were negatively associated with weight change perception, while higher anxiety and a longer duration of confinement correlated with a higher weight change perception. Further studies are necessary to confirm our findings.     

Pilot weight control intervention among US veterans to promote diets high in fruits and vegetables

BackgroundObesity is a significant problem among US veterans. Diets high in fruits and vegetables (FV) can lower obesity risk. Health communication interventions are promising strategies for promoting healthy eating. We evaluated whether an enhanced intervention with tailored newsletters and motivational interviewing calls would be more effective than the Veterans Affairs (VA) weight management program, MOVE!, at increasing FV intake among overweight/obese veterans.MethodsUsing a quasi-experimental design, 195 veterans at two clinics participated at baseline and 6-month follow-up from 2005 to 2006. Measures included daily FV intake and information processing of the intervention. The control group (MOVE!) received educational information, group sessions, and standard phone calls about weight. The intervention included MOVE! components plus tailored newsletters and motivational interviewing calls.ResultsThe intervention group reported a statistically significant increase in FV servings compared to control (1.7 vs. 1.2; p ≤ 0.05). Veterans who read more of the tailored newsletters (β = 0.15, p = 0.01) and perceived the messages as important (β = 0.12, p < 0.01) and applicable to their lives (β = 0.12, p < 0.01) ate more FV than those who did not. However, receiving MI calls and information processing regarding the calls were not associated with FV intake.ConclusionA tailored intervention can impact short term FV intake for obesity prevention.     

Joint effects of objectively-measured sedentary time and physical activity on all-cause mortality

ObjectiveExamine the joint effects of objectively-measured sedentary time and moderate-to-vigorous physical activity (MVPA) on all-cause mortality.MethodsThe present study included data from the 2003–2006 National Health & Nutrition Examination Survey, with mortality follow-up data (via National Death Index) through 2011 (N = 5575 U.S. adults). Sedentary time (activity counts/min between 0 and 99) and MVPA (activity counts/min ≥ 2020) were objectively measured using the ActiGraph 7164 accelerometer.ResultsThe median age of the participants was 50 yrs; proportion of men was 50.2%; proportion of whites was 53.8%, 18.7% for blacks; median follow-up was 81 months; and 511 deaths occurred over the follow-up period. After adjusting for age, gender, race-ethnicity, cotinine, weight status, poverty level, C-reactive protein and comorbid illness (summed score of 0–8 chronic diseases), and for a 1 min increase in MVPA and sedentary time, both MVPA (HR_adjusted = 0.98; 95% CI: 0.96–0.99; P = 0.04) and sedentary time (HR_adjusted = 1.001; 95% CI: 1.0003–1.002; P = 0.008) were independently associated with all-cause mortality. Further, MVPA was associated with all-cause mortality among those with greater (above median) sedentary time (HR_adjusted = 0.95; 95% CI: 0.93–0.97; P < .001). Sedentary time was not associated with all-cause mortality among those engaging in above median levels of MVPA (HR_adjusted = 0.998; 95% CI: 0.996–1.001; P = .32), but sedentary time was associated with increased mortality risk among those below median levels of MVPA (HR = 1.002; 95% CI: 1.001–1.003; P < 0.001).ConclusionsSedentary time and MVPA are independently associated with all-cause mortality. Above median sedentary time levels did not negate the beneficial effects of MVPA on all-cause mortality risk.