Introduction to the Active Living Research Reference List 2007


COMMUNITY BASED INTERVENTIONS



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COMMUNITY BASED INTERVENTIONS
(2007). Results of a community intervention trial on trends in obesity and diabetes: Project DIRECT. Diabetes.

J. J. Annesi, A. D. Faigenbaum, W. L. Westcott, A. E. Smith, J. L. Unruh and F. G. Hamilton. (2007). Effects of the Youth Fit For Life protocol on physiological, mood, self-appraisal, and voluntary physical activity changes in African American preadolescents: Contrasting after-school care and physical education formats. International Journal Of Clinical And Health Psychology.

Effects of a 12-week physical activity and health behavior change protocol (Youth Fit For Life), delivered in 3 day/week after-school care and 2 day/week physical education formats, were assessed and contrasted with African American children, ages 9 to 12 years, in an experimental study. Body Mass Index, percent body fat, and muscular strength were significantly improved in both formats for both boys and girls, with effect sizes larger in the after-school care condition. Significant improvements in mood and self-appraisal factors were also associated with participation in the protocol in both formats, with effect sizes somewhat larger in the physical education format. Increases in days per week of voluntary, moderate-to-vigorous physical activity were significant and similar in both conditions (M-change =.71 and.75 days/week, ps <.01). Multiple regression analyses indicated that changes in scores of physical appearance, physical self-concept, exercise self-efficacy, and perceptions of the overall self explained a significant portion of the variance in changes in voluntary physical activity sessions over 12 weeks, R-2=.24 to.73, ps <.001. Implications for development of an adequate explanatory model of physical activity in children, evidence-based physical activity intervention design, and reduction in overweight preadolescents, were suggested.

T. Arao, Y. Oida, C. Maruyama, T. Mutou, S. Sawada, H. Matsuzuki and Y. Nakanishi. (2007). Impact of lifestyle intervention on physical activity and diet of Japanese workers. Preventive Medicine.

OBJECTIVE: To evaluate the effectiveness of the Life Style Modification Program for Physical Activity and Diet (LiSM-PAN) in comparison to a conventional healthcare program. METHOD: Subjects with risk factor(s) for chronic disease were allocated as a cluster to the LiSM group (n=92) or the Control group (n=85). The LiSM-PAN program consisted of counseling plus social and environment support, and the Control program consisted of written feedback for changing physical activity and dietary practice. Intervention was conducted for 6 months during 2001-2002 and with data analysis during 2003-2004 in Tokyo, Japan. The main outcomes were leisure time exercise energy expenditure (L.E.E.E.), maximum oxygen uptake (VO2max), dietary habits, body mass index (BMI), blood pressure, blood glucose, and lipid parameters. RESULTS: The LiSM group showed a significantly greater increase in L.E.E.E. than the Control group at the end of the intervention (mean inter-group difference: 400.6 kcal/week, 95% CI: 126.1, 675.0 kcal/week). No significant mean inter-group differences were observed in dietary habits. The LiSM group showed significantly greater decreases in BMI, systolic blood pressure, and LDL-cholesterol than the Control group. CONCLUSION: The LiSM-PAN program produced greater positive changes in L.E.E.E., dietary habits, and risk factors for cardiovascular diseases in high-risk middle-aged male workers compared to the Control program.


E. Atlantis, J. Salmon and A. Bauman. (2007). Acute effects of advertisements on children's choices, preferences, and ratings of liking for physical activities and sedentary behaviours: A randomised controlled pilot study. Journal of Science and Medicine in Sport.

The acute decision prompting effects of social marketing via television (TV) advertisements promoting physical activity to children are unknown. This pilot study aimed to determine the acute effects of an Australian government-sponsored TV advertisement (called 'Get Moving'), promoting more physical activity and less sedentary behaviour, on children's choices, preferences, and ratings of liking for physical activities and sedentary behaviours. Thirty-one children aged 10-12 years were recruited from a single public school, and randomised to one of two treatment groups or two control groups (Solomon four-group design). Treatment participants watched an episode of The Simpsons((R)) embedded every 10min with three 30s Get Moving advertisements plus standard advertisements. Control participants watched the same episode plus standard advertisements, but without the Get Moving advertisements. The following dependent variables were assessed immediately before and/or after exposure: activity preference (participants selected either verbally or by pointing to one of eight picture cards depicting four physical activities and four sedentary behaviours); ratings of liking (participants rated how much they liked or disliked each of these activities/behaviours either verbally or by pointing to one of nine values with an adjacent smile or frown on a Likert-type scale); and time spent in physical activities was assessed by direct observation during a 10min free-time session. No significant effects or trends were seen for any of the dependent variables. Further research is needed to determine whether different content and/or higher doses of exposure to physical activity promoting advertisements are needed to influence children's activity choices.


S. B. Austin, J. Kim, J. Wiecha, P. J. Troped, H. A. Feldman and K. E. Peterson. (2007). School-based overweight preventive intervention lowers incidence of disordered weight-control behaviors in early adolescent girls. Archives Of Pediatrics & Adolescent Medicine.

Objective: To determine the effect of a school-based intervention to promote healthful nutrition and physical activity on disordered weight-control behaviors (self-induced vomiting or use of laxatives or diet pills to control weight) in early adolescent girls and boys. Design: Using a group-randomized, controlled-trial design, we randomly assigned middle schools to an intervention or control condition. Multivariate logistic regression analyses were used to assess the effect of the intervention on the odds of reporting a new case of disordered weight-control behaviors at follow-up, adjusting for sex, school-level prevalence of disordered weight-control behaviors at baseline, and school clusters. Students reporting these behaviors at baseline were excluded from the analyses. Setting: Thirteen middle schools. Participants: At baseline, 749 girls and 702 boys in grades 6 and 7. Intervention: The 5-2-1 Go! intervention (Planet Health obesity prevention curriculum plus School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, Middle/High School Version) was implemented during 2 school years, from November 2002 through May 2004. Main Outcome Measure: Self-reported disordered weight-control behaviors in last 30 days at follow-up. Results: At follow-up in girls, 3.6% (15 of 422) in control schools compared with 1.2% (4 of 327) in intervention schools reported engaging in disordered weightcontrol behaviors (P=. 04). Multivariate analyses indicated that the odds of these behaviors in girls in intervention schools were reduced by two thirds compared with girls in control schools (odds ratio, 0.33; 95% confidence interval, 0.11-0.97). No intervention effect was observed in boys. Conclusions: Results add compelling support for the effectiveness of an interdisciplinary, school-based obesity prevention intervention to prevent disordered weightcontrol behaviors in early adolescent girls.

K. Bagby and S. Adams. (2007). Evidence-based practice guideline: increasing physical activity in schools--kindergarten through 8th grade. The Journal of School Nursing.

Because of the growing obesity epidemic across all age groups in the United States, interventions to increase physical activity and reduce sedentary behaviors have become a priority. Evidence is growing that interventions to increase physical activity and reduce sedentary behaviors have positive results and are generally inexpensive to implement. National and international health organizations are calling for a comprehensive approach for reducing obesity in children that includes increasing physical activity in the school setting. Although the call to increase activity levels in schools is clear, little guidance has been given to schools on specific methods to accomplish this task. This article provides an overview of an evidence-based guideline developed by a physical education teacher and a school nurse to provide inexpensive, easy-to-implement, effective strategies to increase physical activity in students. Tools are also included in the guideline to measure the effectiveness of the intervention.

I. R. Baker, B. A. Dennison, P. S. Boyer, K. F. Sellers, T. J. Russo and N. A. Sherwood. (2007). An asset-based community initiative to reduce television viewing in New York state. Preventive Medicine.

Background. Childhood obesity is an epidemic. Addressing this problem will require the input of many sectors and change in many behaviors. The "community" must be part of the solution, and the solution must be constructed on existing assets that lend strength to positive environmental change. Objective. To catalyze an established asset-based community partnership to support efforts to reduce television viewing time by developing and providing alternative activities as part of a broader, 3-year study to reduce childhood obesity among preschool-aged children in rural, upstate New York. Method. Asset mapping was utilized to compile an inventory of individual and community strengths upon which a partnership could be established. Facilitated focus group sessions were conducted to better understand childcare environmental policies and practices, and to guide changes conducive to health and fitness. Planning meetings and targeted outreach brought key stakeholders together for a community-participatory initiative to support positive environmental change. Results. The partnership planned and initiated an array of after-school and weekend community activities for preschool-aged children and their families in the weeks preceding, during, and following a designated 'TV Turn-off week in April, 2004 and March, 2005. Conclusion. Methods of asset-based community development are an effective way to engage community participation in public health initiatives. (C) 2006 Elsevier Inc. All rights reserved.


O. Batik, E. A. Phelan, J. A. Walwick, G. Wang and J. P. LoGerfo. (2008). Translating a community-based motivational support program to increase physical activity among older adults with diabetes at community clinics: a pilot study of Physical Activity for a Lifetime of Success (PALS). Preventing Chronic Disease.

BACKGROUND: Regular physical activity is an important goal for elders with chronic health conditions. CONTEXT: This report describes Physical Activity for a Lifetime of Success (PALS), an attempt to translate a motivational support program for physical activity, Active Choices, for use by a group of diverse, low-income, community-dwelling elders with diabetes. METHODS: PALS linked physical activity assessment and brief counseling by primary care providers with a structured referral to a community-based motivational telephone support program delivered by older adult volunteers. People with diabetes aged 65 years or older who were receiving care at two community clinics were randomized to receive either immediate or delayed intervention. The main intended outcome measure was physical activity level; the secondary outcome measure was mean hemoglobin A1c. CONSEQUENCES: One-third of those offered referral to the PALS program in the clinic setting declined. Another 44% subsequently declined enrollment or were unreachable by the support center. Only 14 (21%) of those offered referral enrolled in the program. Among these 14, the percentage who were sufficiently active was higher at follow-up than at enrollment, though not significantly so. Using an intent-to-treat analysis, which included all randomized clinic patients, we found no significant change in mean hemoglobin A1c for the intervention group compared with controls. INTERPRETATION: A community-based referral and support program to increase physical activity among elderly, ethnically diverse, low-income people with diabetes, many of whom are not English-speaking, may be thwarted by unforeseen barriers. Those who enroll and participate in the PALS program appear to increase their level of physical activity.

C. E. Beaudoin, C. Fernandez, J. L. Wall and T. A. Farley. (2007). Promoting healthy eating and physical activity - Short-term effects of a mass media campaign. American Journal Of Preventive Medicine.

Background: Soaring obesity levels present a severe health risk in the United States, especially in low-income minority populations. Intervention: High-frequency paid television and radio advertising, as well as bus and streetcar signage. Setting/Participants: A mass media campaign in New Orleans to promote walking and fruit and vegetable consumption in a low-income, predominantly African-American urban population. Messages tailored with consideration of the African-American majority. Design: Random-digit-dial telephone surveys using cross-sectional representative samples at baseline in 2004 and following the onset of the campaign in 2005. Measures: Survey items on campaign message recall; attitudes toward walking, snack food avoidance, and fruit and vegetable consumption; and behaviors related to fruit and vegetable consumption, snack food consumption, and utilitarian and leisure walking. Results: From baseline, there were significant increases in message recall measures, positive attitudes toward fruit and vegetable consumption, and positive attitudes toward walking. Behaviors did not change significantly. In 2005, message recall measures were associated with positive levels of each of the outcome variables. Conclusions: Over 5 months, the media campaign appeared to have stimulated improvements in attitudes toward healthy diet and walking behaviors addressed by the campaign. These findings encourage the continuation of the media campaign, with future evaluation to consider whether the behavioral measures change. (Am J Prev Med 2007;32 (3):217-223) (c) 2007 American journal of Preventive Medicine.

S. Benedict, M. Campbell, A. Doolen, I. Rivera, T. Negussie and G. Turner-McGrievy. (2007). Seeds of HOPE: A model for addressing social and economic determinants of health in a women's obesity prevention project in two rural communities. Journal Of Womens Health.

Socioeconomic status (SES) and income disparity are strong predictors of health, and health promotion interventions that address them are more likely to be meaningful to participants and to sustain positive effects. Seeds of HOPE is an innovative project that is the result of a long- standing collaboration between the University of North Carolina (UNC) Center for Health Promotion and Disease Prevention, a Centers for Disease Control and Prevention (CDC) Prevention Research Center, and communities in rural North Carolina. Initial formative work, including key informant interviews, community surveys, and focus groups, strengthened our understanding of the link between hope and health and the importance of addressing social and economic issues as part of our health promotion interventions. A Seeds of HOPE strategic plan was developed using a community- based participatory process and led to the idea to start Threads of HOPE, an enterprise that will serve as a business laboratory where women will produce and market a unique product and also learn business skills. Threads of HOPE will be a health-enhancing business and will serve as a training program for a new cadre of women entrepreneurs in two rural communities.

S. E. Benjamin, A. Ammerman, J. Sommers, J. Dodds, B. Neelon and D. S. Ward. (2007). Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention. Journal of Nutrtion Education and Behavior.

OBJECTIVE: To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care. DESIGN: Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers. SETTING: Child care centers in 8 counties across North Carolina. PARTICIPANTS: A convenience sample of 19 child care centers (15 intervention and 4 comparison). INTERVENTION: Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant. MAIN OUTCOME MEASURE: Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability. ANALYSIS: Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes. RESULTS: Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff. CONCLUSIONS AND IMPLICATIONS: The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.

L. Blank, M. Grimsley, E. Goyder, E. Ellis and J. Peters. (2007). Community-based lifestyle interventions: changing behaviour and improving health. Journal of Public Health (Oxf).

OBJECTIVE: To explore the association between change in physical activity levels and fruit and vegetable consumption and changes in self-reported overall health and mental health, of residents living in deprived English communities. DESIGN: Household survey conducted in 2002 and repeated in 2004. SETTING: Thirty-nine deprived UK communities in areas participating in the New Deal for Communities (NDCs), a major government funded community development initiative. PARTICIPANTS: Ten thousand four hundred and nineteen residents in NDC areas and neighbouring comparator areas. MAIN RESULTS: Overall levels of physical activity and fruit and vegetable consumption are low but a large positive change in diet or levels of physical activity is associated with a significant change in mental health (2.86 and 2.71, respectively: P < 0.01). Smaller, but also statistically significant, changes were found in physical health (0.07 and 0.05, P < 0.01). Specific dimensions of mental health which showed a large change in association with lifestyle change were those associated with 'peacefulness' and 'happiness'. CONCLUSIONS: These findings suggest that, for residents of these neighbourhoods, positive lifestyle changes such as increasing physical activity levels and increase in fruit and vegetable consumption are associated with positive changes in mental health. WHAT THIS PAPER ADDS: What is already known? Mental health, a key area of health inequality is related to physical health, and associated with education, employment, environment and community issues. There is known to be a relationship between improved lifestyle (increased physical activity levels and better diet) and better health. What does this study add? This study shows that over two years, measurable changes in lifestyle were associated with improvements in both mental health and self-reported overall health. The association of lifestyle changes with overall health, although statistically significant, were less significant than those with mental health over the same period, suggesting those wanting to measure the impact of community activity on health will be more likely to see a measurable short-term impact on mental, rather than overall self-reported health.


D. A. Bluford, B. Sherry and K. S. Scanlon. (2007). Interventions to prevent or treat obesity in preschool children: a review of evaluated programs. Obesity (Silver Spring).

OBJECTIVE: To identify effective programs to prevent or treat overweight among 2- to <6-year-old children. RESEARCH METHODS AND PROCEDURES: We searched six databases to identify evaluated intervention programs assessing changes in weight status or body fat and systematically summarized study attributes and outcomes. RESULTS: Four of the seven studies (two intervention, two prevention) documented significant reductions in weight status or body fat. Among these, three sustained reductions at 1 or 2 years after program initiation, three incorporated a framework/theory, two actively and one passively involved parents, three included multicomponent strategies, and all four monitored behavioral changes. Of the three (prevention) studies that did not show reduction in weight or fat status, all performed assessments between 4 and 9 months after program initiation, and one used a multicomponent strategy. Other significant changes reported were reductions in television viewing, cholesterol, and parental restriction of child feeding. DISCUSSION: The paucity of studies limits our ability to generalize findings. Among the available studies, multicomponent programs with 1- to 2-year follow-up in clinics or child care settings were successful in their impact on weight; they were likely enhanced by parental involvement. Both treatment programs and two of five prevention programs reduced weight/fat status. Our review highlights the need to evaluate more programs, advocate for use of a framework/behavioral theory and objective behavioral measures, further examine the impact of involving parents and the impact of intervention duration and follow-up time, strengthen prevention programs, and further evaluate successful programs in other settings and among other racial/ethnic groups.

M. Bopp, S. Wilcox, M. Laken, S. P. Hooker, R. Saunders, D. Parra-Medina, K. Butler and L. McClorin. (2007). Using the RE-AIM framework to evaluate a physical activity intervention in churches. Preventing Chronic Disease.

INTRODUCTION: Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors. METHODS: We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors. RESULTS: Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention's physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity. CONCLUSION: Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.

J. M. Borys, M. Romon and S. Raffib. (2007). Preventing childhood obesity: EPODE, a successful long term integrated community approach. International Journal Of Obesity.
C. Bradley and M. Hemman. (2007). Studies of health promotion and weight control in Community Pharmacy in the Republic of Ireland. Pharmacy World & Science.



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