Medicine and Health Sciences Commons^™

Driving Qi With Research: Findings From Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

College Of Public Health News, Georgia Southern University

Jiann-Ping Hsu College of Public Health News (2011-2023)

• Georgia Southern University's Jiann-Ping Hsu College of Public Health receives grant from the Robert Wood Johnson Foundation

Long-Term Effects Of Changes In Cardiorespiratory Fitness And Body Mass Index On All-Cause And Cardiovascular Disease Mortality In Men: The Aerobics Center Longitudinal Study, Duck-Chul Lee, Xuemei Sui, Enrique G. Artero, I-Min Lee, Timothy S. Church, Paul A. Mcauley, Fatima C. Stanford, Harold W. Kohl Iii, Steven N. Blair

Faculty Publications

Background - The combined associations of changes in cardiorespiratory fitness and body mass index (BMI) with mortality remain controversial and uncertain.

Methods and Results - We examined the independent and combined associations of changes in fitness and BMI with all-cause and cardiovascular disease (CVD) mortality in 14,345 men (mean age 44 years) with at least 2 medical examinations. Fitness, in metabolic equivalents (METs), was estimated from a maximal treadmill test. BMI was calculated using measured weight and height. Changes in fitness and BMI between the baseline and last examinations over 6.3 years were classified into loss, stable, or gain groups. …

Associations Between Physical Activity And Submaximal Cardiorespiratory And Pulmonary Responses In Men, John C. Sieverdes, Xuemei Sui, Steven N. Blair

Faculty Publications

Background: Habitual physical activity (PA) is associated with higher cardiorespiratory fitness values, but additional information is needed on the contributions of specific types and amounts of PA. Therefore the main aim of this study was to analyze the heart and lung function of a large cohort of men and compare these outcomes with various modes and volumes of PA.

Methods: We used data from 30,594 men from the Aerobics Center Longitudinal Study who were categorized into sedentary, swimmer, walker, and runner groups using self-report PA data collected during 1970-2005. Additional PA categories using MET-minutes/week were used to group men into …

College Of Public Health News, Georgia Southern University

Jiann-Ping Hsu College of Public Health News (2011-2023)

• JPHCOPH Attends 139th American Public Health Association Meeting in Washington D.C

Disparities Research In Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

A Randomized Trial Of A Diet And Exercise Intervention For Overweight And Obese Women From Economically Disadvantaged Neighborhoods: Sisters Taking Action For Real Success (Stars), Sarah Wilcox, Patricia A. Sharpe, Deborah Parra-Medina, Michelle L. Granner, Brent E. Hutto

Faculty Publications

Background - Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight loss studies target this population.

Objectives - STARS tests a culturally-appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods.

Design - A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes.

Methods - Participants 25-50 years who had a BMI ≥ 25 kg/m² and a waist circumference ≥ …

Prescribing Exercise In Primary Care: Ten Practical Steps On How To Do It, Karim M. Khan, Richard Weller, Steven N. Blair

Faculty Publications

No abstract provided.

Combined Impact Of Lifestyle Factors On Cancer Mortality In Men, Chong-Do Lee, Xuemei Sui, Steven P. Hooker, James R. Hébert, Steven N. Blair

Faculty Publications

PURPOSE - The impact of lifestyle factors on cancer mortality in the U.S. population has not been thoroughly explored. We examined the combined effects of cardiorespiratory fitness, never smoking, and normal waist girth on total cancer mortality in men.

METHODS - We followed a total of 24,731 men ages 20-82 years who participated in the Aerobics Center Longitudinal Study. A low-risk profile was defined as never smoking, moderate or high fitness, and normal waist girth, and they were further categorized as having 0, 1, 2, or 3 combined low-risk factors.

RESULTS - During an average of 14.5 years of follow-up, …

Effect Of School Racial Composition On Trajectories Of Depressive Symptoms From Adolescence Through Early Adulthood, Katrina M. Walsemann, Bethany A. Bell, Bridget J. Goosby

Faculty Publications

Introduction: We investigate the effect of high school racial composition, measured as percent of non-Hispanic White students, on trajectories of depressive symptoms from adolescence to early adulthood. We also explore whether the effect of school racial composition varies by respondent race/ethnicity and if adult socio-economic status mediates this relationship.

Methods: We analyzed four waves of data from the National Longitudinal Study of Adolescent Health using 3-level linear growth models. We restricted our sample to respondents enrolled in grades 9-12 in 1994/5 who were interviewed at a minimum in Waves I and IV. This resulted in 10,350 respondents enrolled in 80 …

Stimulant Reduction Intervention Using Dosed Exercise (Stride) - Ctn 0037: Study Protocol For A Randomized Controlled Trial, Madhukar H. Trivedi, Tracy L. Greer, Bruce D. Grannemann, Timothy S. Church, Eugene Somoza, Steven N. Blair, Jose Szapocznik, Mark Stoutenberg, Chad Rethorst, Diane Warden, Kolette M. Ring, Robrina Walker, David W. Morris, Andrzej S. Kosinski, Tiffany Kyle, Bess H. Marcus, Becca Crowell, Neal Oden, Edward Nunes

Faculty Publications

Background: There is a need for novel approaches to the treatment of stimulant abuse and dependence. Clinical data examining the use of exercise as a treatment for the abuse of nicotine, alcohol, and other substances suggest that exercise may be a beneficial treatment for stimulant abuse, with direct effects on decreased use and craving. In addition, exercise has the potential to improve other health domains that may be adversely affected by stimulant use or its treatment, such as sleep disturbance, cognitive function, mood, weight gain, quality of life, and anhedonia, since it has been shown to improve many of these …

Associations Of American Indian Children's Screen-Time Behavior With Parental Television Behavior, Parental Perceptions Of Children's Screen Time, And Media-Related Resources In The Home, Daheia J. Barr-Anderson, Jayne A. Fulkerson, Mary Smyth, John H. Himes, Peter J. Hannan, Bonnie Holy Rock, Mary Story

Faculty Publications

Introduction: American Indian children have high rates of overweight and obesity, which may be partially attributable to screen-time behavior. Young children's screen-time behavior is strongly influenced by their environment and their parents' behavior. We explored whether parental television watching time, parental perceptions of children's screen time, and media-related resources in the home are related to scree time (ie, television, DVD/video, video game, and computer use) among Oglala Lakota youth residing on or near the Pine Ridge Reservation in South Dakota.

Methods: We collected baseline data from 431 child and parent/caregiver pairs who participated in Bright Start, a group-randomized, controlled, school-based …

Pathways To Sexual Risk Taking Among Female Adolescent Detainees, Vera Lopez, Albert M. Kopak, Alyssa G. Robillard, Mary Rogers Gillmore, Rhonda Conerly Holliday, Ronald L. Braithwaite

Faculty Publications

Sexual risk taking among female delinquents represents a significant public health problem. Research is needed to understand the pathways leading to sexual risk taking among this population. This study sought to address this issue by identifying and testing two pathways from child maltreatment to non-condom use among 329 White and 484 African American female adolescent detainees: a relational pathway and a substance use coping pathway. The relational pathway indicated that child maltreatment would be related to non-condom use via depressive self-concept and condom use self-efficacy. The substance use coping pathway suggested that depressive self-concept and alcohol-based expectancies for sexual enhancement …

How Many Steps/Day Are Enough? For Children And Adolescents, Catrine Tudor-Locke, Cora L. Craig, Michael W. Beets, Sarahjane Belton, Greet M. Cardon, Scott Duncan, Yoshiro Hatano, David R. Lubans, Timothy S. Olds, Anders Raustorp, David A. Rowe, John C. Spence, Shigeho Tanaka, Steven N. Blair

Faculty Publications

Worldwide, public health physical activity guidelines include special emphasis on populations of children (typically 6-11 years) and adolescents (typically 12-19 years). Existing guidelines are commonly expressed in terms of frequency, time, and intensity of behaviour. However, the simple step output from both accelerometers and pedometers is gaining increased credibility in research and practice as a reasonable approximation of daily ambulatory physical activity volume. Therefore, the purpose of this article is to review existing child and adolescent objectively monitored step-defined physical activity literature to provide researchers, practitioners, and lay people who use accelerometers and pedometers with evidence-based translations of these public …

How Many Steps/Day Are Enough? For Adults, Catrine Tudor-Locke, Cora L. Craig, Wendy J. Brown, Stacy A. Clemes, Katrien Decocker, Billie Giles-Corti, Yoshiro Hatano, Shigeru Inoue, Sandra M. Matsudo, Nanette Mutrie, Jean-Michel Oppert, David A. Rowe, Michael D. Schmidt, Grant M. Schofield, John C. Spence, Pedro J. Teixeira, Mark A. Tully, Steven N. Blair

Faculty Publications

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions and translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognized that "some physical activity is better than none" while maintaining a focus …

How Many Steps/Day Are Enough? For Older Adults And Special Populations, Catrine Tudor-Locke, Cora L. Craig, Yukitoshi Aoyagi, Rhonda C. Bell, Karen A. Croteau, Ilse De Bourdeaudhuij, Ben Ewald, Andrew W. Gardner, Yoshiro Hatano, Lesley D. Lutes, Sandra M. Matsudo, Farah A. Ramirez-Marrero, Laura Q. Rogers, Davod A. Rowe, Michael D. Schmidt, Mark A. Tully, Steven N. Blair

Faculty Publications

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations …

Adherence To Accelerometer Protocols Among Women From Economically Disadvantaged Neighborhoods, Patricia A. Sharpe, Sarah Wilcox, Laura J. Rooney, Donna Strong, Rosie Hopkins-Campbell, Jean Butel, Barbara E. Ainsworth, Deborah Parra-Medina

Faculty Publications

Background: Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations. Methods: Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, …

Media Attention On African Americans With Human Immunodeficiency Virus, Charles S. Beverley Jr., Edith M. Williams, Saundra H. Glover

Faculty Publications

Human immunodeficiency virus (HIV) is a disease that has captured the attention of the media in various ways and to varying degrees. One of the ongoing debates and areas of research in HIV that provide many opportunities for discovery is the disproportionate number of African Americans infected with HIV compared to the amount of attention they receive in the media. This manuscript addresses the question that has preoccupied the minds of many people: Why have African Americans infected with HIV received so little media attention? Analysis of this question suggests that there are many reasons for this lack of media …

Cardiometabolic Results From An Armband-Based Weight Loss Trial, John C. Sieverdes, Xuemei Sui, Gregory A. Hand, Vaughn W. Barry, Sarah Wilcox, Rebecca A. Meriwether, James W. Hardin, Amanda C. Mcclain, Steven N. Blair

Faculty Publications

Purpose: This report examines the blood chemistry and blood pressure (BP) results from the Lifestyle Education for Activity and Nutrition (LEAN) study, a randomized weight loss trial. A primary purpose of the study was to evaluate the effects of real-time self-monitoring of energy balance (using the SenseWear^TM Armband, BodyMedia, Inc Pittsburgh, PA) on these health factors.

Methods: 164 sedentary overweight or obese adults (46.8 ± 10.8 years; BMI 33.3 ± 5.2 kg/m²; 80% women) took part in the 9-month study. Participants were randomized into 4 conditions: a standard care condition with an evidence-based weight loss manual (n …

Electronic Feedback In A Diet- And Physical Activity-Based Intervention For Weight Loss: A Randomized Controlled Trial, Sara L. Shuger, Vaughn W. Barry, Xuemei Sui, Amanda C. Mcclain, Gregory A. Hand, Sarah Wilcox, Rebecca A. Meriwether, James W. Hardin, Steven N. Blair

Faculty Publications

Background: The SenseWear^TM Armband (SWA) (BodyMedia, Inc. Pittsburgh, PA) is a physical activity and lifestyle monitor that objectively and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake. The real-time feedback of the SWA can improve individual self-monitoring and, therefore, enhance weight loss outcomes.

Methods: We recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 y; body mass index (BMI), 33.3 ± 5.2 kg/m²; 81% women, 32% African-American) from the greater Columbia, South Carolina area. Participants were randomized into 1 of 4 groups, a self-directed …

Trends Over 5 Decades In U.S. Occupation-Related Physical Activity And Their Associations With Obesity, Timothy S. Church, Diana M. Thomas, Catrine Tudor-Locke, Peter T. Katzmarzyk, Conrad P. Earnest, Ruben Q. Rodarte, Corby K. Martin, Steven N. Blair, Claude Bouchard

Faculty Publications

Background: The true causes of the obesity epidemic are not well understood and there are few longitudinal population-based data published examining this issue. The objective of this analysis was to examine trends in occupational physical activity during the past 5 decades and explore how these trends relate to concurrent changes in body weight in the U.S.

Methodology/Principle Findings: Analysis of energy expenditure for occupations in U.S. private industry since 1960 using data from the U.S. Bureau of Labor Statistics. Mean body weight was derived from the U.S. National Health and Nutrition Examination Surveys (NHANES). In the early 1960's almost half …

Physical Activity And Sedentary Activity Patterns Among Children And Adolescents: A Latent Class Analysis Approach, Carrie D. Patnode, Leslie A. Lytle, Darin J. Erickson, John R. Sirard, Daheia J. Barr-Anderson, Mary Story

Faculty Publications

Background: While much is known about the overall levels of physical activity and sedentary activity among youth, few studies have attempted to define clusters of such behaviors. The purpose of this study was to identify and describe unique classes of youth based on their perception in a variety of physical activity and sedentary behaviors. Methods: Latent class analysis was used to characterize segments of youth based on patterns of self-reported and accelerometer-measured participation in 12 behaviors. Children and adolescents (N =720) from 6th-11th grade were included in the analysis. Differences in class membership were examined using multinomial logistic …

Bmi Trajectories During The Transition To Older Adulthood: Persistent, Widening, Or Diminishing Disparities By Ethnicity And Education?, Katrina M. Walsemann, Jennifer A. Ailshire

Faculty Publications

Previous research has produced inconsistent results on whether education and ethnic disparities in BMI persist, widen, or diminish over time. We investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, we analyzed 8 biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated white men and both low-educated Hispanic men and high-educated black …

Validation Of The Actical Activity Monitor In Middle-Aged And Older Adults, Steven P. Hooker, Anna Feeney, Brent E. Hutto, Karin A. Pfeiffer, Kerry Mciver, Daniel P. Heil, John E. Vena, Michael J. Lamonte, Steven N. Blair

Faculty Publications

Purpose: This study was designed to validate the Actical activity monitor in middle-aged and older adults of varying body composition to develop accelerometer thresholds to distinguish between light and moderate intensity physical activity (PA).

Methods: Nonobese 45 to 64 yr (N = 29), obese 45 to 64 yr (N = 21), and ≥65 yr (N = 23; varying body composition) participants completed laboratory-based sitting, household, and locomotive activities while wearing an Actical monitor and a portable metabolic measurement system. Non-linear regression analysis was used to identify activity count (AC) cut-points to differentiate between light intensity (<3 METs) and moderate intensity (≥3 METs) PA.

Results: Using group-specific algorithms, …

Circadian Rhythm Of Cortisol And Neighborhood Characteristics In A Population-Based Sample: The Multi-Ethnic Study Of Atherosclerosis, D. Phuong Do, Ana V. Diez Roux, Anjum Hajat, Amy Auchincloss, Sharon Merkin, Nalini Ranjit, Steven Shea, Teresa Seeman

Faculty Publications

Although stress is often hypothesized to contribute to the effects of neighborhoods on health, very few studies have investigated associations of neighborhood characteristics with stress biomarkers. This study helps address the gap in the literature by examining whether neighborhood characteristics are associated with cortisol profiles. Analyses were based on data from the Multi-Ethnic Study of Atherosclerosis Stress study which collected multiple measures of salivary cortisol over three days on a population based sample of approximately 800 adults. Multilevel models with splines were used to examine associations of cortisol with neighborhood poverty, violence, disorder, and social cohesion. Neighborhood violence was significantly …

Using A Technology-Based Intervention To Promote Weight Loss In Sedentary Overweight Or Obese Adults: A Randomized Controlled Trial Study Design, Vaughn W. Barry, Amanda C. Mcclain, Sara L. Shuger, Xuemei Sui, James W. Hardin, Gregory A. Hand, Sarah Wilcox, Steven N. Blair

Faculty Publications

Purpose: The SenseWear^TM Armband is an activity monitor developed to improve lifestyle self-monitoring. Currently, few studies assess electronic self-monitoring and weight loss with a lifestyle intervention program. To our knowledge, only one study has used the SenseWear Armband in combination with a lifestyle intervention to improve weight loss, and no studies have evaluated whether a self-monitoring intervention based solely on the armband can promote weight loss. Consequently, the aims of the study were to assess weight loss from electronic self-monitoring, to compare these values to the lifestyle intervention and standard care groups, and to compare weight loss with lifestyle …

Cardiorespiratory Fitness And Risk Of Prostate Cancer: Findings From The Aerobics Center Longitudinal Study, Wonwoo Byun, Xuemei Sui, James R. Hébert, Timothy S. Church, I-Min Lee, Charles E. Matthews, Steven N. Blair

Faculty Publications

Objective - To examine the association between cardiorespiratory (CRF) and risk of incident prostate cancer (PrCA).

Methods - Participants were 19,042 male subjects in the Aerobics Center Longitudinal Study (ACLS), ages 20 to 82 years, who received a baseline medical examination including a maximal treadmill exercise test between 1976 and 2003. CRF levels were defined as low (lowest 20%), moderate (middle 40%), and high (upper 40%) according to age-specific distribution of treadmill duration from the overall ACLS population. PrCA was assessed from responses to mail-back health surveys during 1982 to 2004. Cox proportional hazards regression models, adjusted for potential confounders, …

Education And Levels Of Salivary Cortisol Over The Day In Us Adults, Jennifer B. Dowd, Nalini Ranjit, D. Phuong Do, Elizabeth A. Young, James S. House, George A. Kaplan

Faculty Publications

Background - Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is hypothesized to be an important pathway linking socioeconomic position and chronic disease.

Purpose - This paper tests the association between education and the diurnal rhythm of salivary control.

Methods - Up to 8 measures of cortisol (mean of 5.38 per respondent) over two days were obtained from 311 respondents aged 18-70, drawn from 2001-2002 Chicago Community Adult Health Study. Multi-level models with linear splines were used to estimate waking level, rates of cortisol decline, and area-under-the-curve over the day, by categories of education.

Results - Lower education (0-11 years) was associated …

Changes In Cvd Risk Factors In The Activity Counseling Trial, Meghan Baruth, Sarah Wilcox, James F. Sallis, Abby C. King, Bess H. Marcus, Steven N. Blair

Faculty Publications

Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35-74 years. Participants were randomly assigned to …

Diabetes And The Socioeconomic And Built Environment: Geovisualization Of Disease Prevalence And Potential Contextual Associations Using Ring Maps, John E. Stewart, Sarah E. Battersby, Ana Lopez-De Fede

Publications

Efforts to stem the diabetes epidemic in the United States and other countries must take into account a complex array of individual, social, economic, and built environmental factors. Increasingly, scientists use information visualization tools to "make sense" of large multivariate data sets. Recently, ring map visualization has been explored as a means of depicting spatially referenced, multivariate data in a single information graphic. A ring map shows multiple attribute data sets as separate rings of information surrounding a base map of a particular geographic region of interest. In this study, ring maps were used to evaluate diabetes prevalence among adult …