American Journal of Preventive Medicine

Exergaming and Older Adult Cognition: A Cluster Randomized Clinical Trial

2012-02-01

Background: Dementia cases may reach 100 million by 2050. Interventions are sought to curb or prevent cognitive decline. Exercise yields cognitive benefits, but few older adults exercise. Virtual reality–enhanced exercise or “exergames” may elicit greater participation. Purpose: To test the following hypotheses: (1) stationary cycling with virtual reality tours (“cybercycle”) will enhance executive function and clinical status more than traditional exercise; (2) exercise effort will explain improvement; and (3) brain-derived neurotrophic growth factor (BDNF) will increase. Design: Multi-site cluster randomized clinical trial (RCT) of the impact of 3 months of cybercycling versus traditional exercise, on cognitive function in older adults. Data were collected in 2008–2010; analyses were conducted in 2010–2011. Setting/participants: 102 older adults from eight retirement communities enrolled; 79 were randomized and 63 completed. Interventions: A recumbent stationary ergometer was utilized; virtual reality tours and competitors were enabled on the cybercycle. Main outcome measures: Executive function (Color Trails Difference, Stroop C, Digits Backward); clinical status (mild cognitive impairment; MCI); exercise effort/fitness; and plasma BDNF. Results: Intent-to-treat analyses, controlling for age, education, and cluster randomization, revealed a significant group X time interaction for composite executive function (p=0.002). Cybercycling yielded a medium effect over traditional exercise (d=0.50). Cybercyclists had a 23% relative risk reduction in clinical progression to MCI. Exercise effort and fitness were comparable, suggesting another underlying mechanism. A significant group X time interaction for BDNF (p=0.05) indicated enhanced neuroplasticity among cybercyclists. Conclusions: Cybercycling older adults achieved better cognitive function than traditional exercisers, for the same effort, suggesting that simultaneous cognitive and physical exercise has greater potential for preventing cognitive decline. Trial registration: This study is registered at Clinicaltrials.gov NCT01167400.

Active Commuting to School Among Adolescents in Ho Chi Minh City, Vietnam: Change and Predictors in a Longitudinal Study, 2004 to 2009

Nguyen H.H.D. Trang, Tang K. Hong, Michael J. Dibley — 2012-02-01

Background: Active commuting (walking or cycling) to/from school is an important part of the overall physical activity levels of children but is on the decline in many countries. Data for adolescents on mode of transportation to and from school are limited for low- and middle-income countries, including Vietnam. Purpose: This paper aims to describe the changes in the prevalence of active commuting to and from school, and to examine prospectively the predictors of active commuting, among adolescents from Ho Chi Minh City (HCMC). Methods: The data are from a 5-year cohort study from 2004 of a representative sample of 759 adolescents from 18 schools in HCMC. Data were obtained at five annual assessments using validated questionnaires to capture commuting behaviors, socioeconomic and demographic factors, individual and family characteristics, and physical and social environmental factors. Height and weight were measured by trained staff using standardized guidelines. Generalized linear latent and mixed models with a hierarchic approach were used to analyze the data in 2011. Results: The results show a remarkable decrease in the prevalence of active commuting in adolescents from 27.8% in 2004 to 19.6% in 2009. Male students, from the least-wealthy families, living in suburban areas, close to school, studying at schools in less-wealthy districts, were more likely to actively commute. Conclusions: In the context of an epidemic of childhood and adolescent obesity in urban Vietnam, the decline in active commuting over the 5 years of this study highlights the need for development of urban physical environments favorable for active commuting and education campaigns to promote active commuting in adolescents.

School and Residential Neighborhood Food Environment and Diet Among California Youth

Ruopeng An, Roland Sturm — 2012-02-01

Background: Various hypotheses link neighborhood food environments and diet. Greater exposure to fast-food restaurants and convenience stores is thought to encourage overconsumption; supermarkets and large grocery stores are claimed to encourage healthier diets. For youth, empirical evidence for any particular hypothesis remains limited. Purpose: This study examines the relationship between school and residential neighborhood food environment and diet among youth in California. Methods: Data from 8226 children (aged 5–11 years) and 5236 adolescents (aged 12–17 years) from the 2005 and 2007 California Health Interview Survey were analyzed in 2011. The dependent variables are daily servings of fruits, vegetables, juice, milk, soda, high-sugar foods, and fast food, which were regressed on measures of food environments. Food environments were measured by counts and density of businesses, distinguishing fast-food restaurants, convenience stores, small food stores, grocery stores, and large supermarkets within a specific distance (varying from 0.1 to 1.5 miles) from a respondent's home or school. Results: No robust relationship between food environment and consumption is found. A few significant results are sensitive to small modeling changes and more likely to reflect chance than true relationships. Conclusions: This correlational study has measurement and design limitations. Longitudinal studies that can assess links between environmental, dependent, and intervening food purchase and consumption variables are needed. Reporting a full range of studies, methods, and results is important as a premature focus on correlations may lead policy astray.

Promoting Routine Stair Use: Evaluating the Impact of a Stair Prompt Across Buildings

2012-02-01

Background: Although studies have demonstrated that stair prompts are associated with increased physical activity, many were conducted in low-rise buildings over a period of weeks and did not differentiate between stair climbing and descent. Purpose: This study evaluated the impact of a prompt across different building types, and on stair climbing versus descent over several months. Methods: In 2008–2009, stair and elevator trips were observed and analyzed at three buildings in New York City before and after the posting of a prompt stating “Burn Calories, Not Electricity” (total observations=18,462). Sites included a three-story health clinic (observations=4987); an eight-story academic building (observations=5151); and a ten-story affordable housing site (observations=8324). Stair and elevator trips up and down were recorded separately at the health clinic to isolate the impact on climbing and descent. Follow-up was conducted at the health clinic and affordable housing site to assess long-term impact. Results: Increased stair use was seen at all sites immediately after posting of the prompt (range=9.2%–34.7% relative increase, p<0.001). Relative increases in stair climbing (20.2% increase, p<0.001) and descent (4.4% increase, p<0.05) were seen at the health clinic. At both sites with long-term follow-up, relative increases were maintained at 9 months after posting compared to baseline: 42.7% (p<0.001) increase in stair use at the affordable housing site and 20.3% (p<0.001) increase in stair climbing at the health clinic. Conclusions: Findings suggest that the prompt was effective in increasing physical activity in diverse settings, and increases were maintained at 9 months.

Self-Reported Alcohol-Impaired Driving in the U.S., 2006 and 2008

Gwen Bergen, Ruth A. Shults, Laurie F. Beck, Mohamed Qayad — 2012-02-01

Background: Alcohol-impaired driving caused 10,839 deaths in 2009. Alcohol-impaired driving fatalities as a percentage of all motor vehicle fatalities decreased from 1982 to 1999 but have remained stable since. Understanding characteristics of those who engage in this behavior is critical to achieving future reductions. Purpose: The purpose of this study is to estimate the number of episodes of self-reported alcohol-impaired driving and to explore the related demographic factors and drinking patterns. Methods: Data from the 2006 and 2008 Behavioral Risk Factor Surveillance System were used in 2010 to produce annualized estimates of alcohol-impaired driving episodes. Logistic regression modeling was used to explore the effects of drinking patterns, seatbelt use, and sociodemographics. Results: The percentage of the population reporting at least one alcohol-impaired driving episode in the past 30 days was 2.2% for 2006 and 2008 combined. The number of annualized episodes of alcohol-impaired driving was 147 million. Annualized episode rates varied across states from 165 to 1242 episodes per 1000 population. Characteristics associated with alcohol-impaired driving differed by gender. The strongest correlate of alcohol-impaired driving was binge drinking, with those reporting binge drinking at least once per month being five to six times as likely to report alcohol-impaired driving when adjusting for all other variables. Conclusions: Understanding who is most likely to report alcohol-impaired driving is important in developing interventions to prevent this behavior. Interventions that are known to be effective, such as sobriety checkpoints and installing ignition interlocks on the vehicles of people convicted of alcohol-impaired driving, should be widely implemented.

U.S. Hookah Tobacco Smoking Establishments Advertised on the Internet

2012-02-01

Background: Establishments dedicated to hookah tobacco smoking recently have proliferated and helped introduce hookah use to U.S. communities. Purpose: To conduct a comprehensive, qualitative assessment of websites promoting these establishments. Methods: In June 2009, a systematic search process was initiated to access the universe of websites representing major hookah tobacco smoking establishments. In 2009–2010, codebook development followed an iterative paradigm involving three researchers and resulted in a final codebook consisting of 36 codes within eight categories. After two independent coders had nearly perfect agreement (Cohen's κ = 0.93) on double-coding the data in the first 20% of sites, the coders divided the remaining sites and coded them independently. A thematic approach to the synthesis of findings and selection of exemplary quotations was used. Results: The search yielded a sample of 144 websites originating from states in all U.S. regions. Among the hookah establishments promoted on the websites, 79% served food and 41% served alcohol. Of the websites, none required age verification, <1% included a tobacco-related warning on the first page, and 4% included a warning on any page. Although mention of the word tobacco was relatively uncommon (appearing on the first page of only 26% sites and on any page of 58% of sites), the promotion of flavorings, pleasure, relaxation, product quality, and cultural and social aspects of hookah smoking was common. Conclusions: Websites may play a role in enhancing or propagating misinformation related to hookah tobacco smoking. Health education and policy measures may be valuable in countering this misinformation.

Assessing the Value of Team Science: A Study Comparing Center- and Investigator-Initiated Grants

2012-02-01

Background: Large cross-disciplinary scientific teams are becoming increasingly prominent in the conduct of research. Purpose: This paper reports on a quasi-experimental longitudinal study conducted to compare bibliometric indicators of scientific collaboration, productivity, and impact of center-based transdisciplinary team science initiatives and traditional investigator-initiated grants in the same field. Methods: All grants began between 1994 and 2004 and up to 10 years of publication data were collected for each grant. Publication information was compiled and analyzed during the spring and summer of 2010. Results: Following an initial lag period, the transdisciplinary research center grants had higher overall publication rates than the investigator-initiated R01 (NIH Research Project Grant Program) grants. There were relatively uniform publication rates across the research center grants compared to dramatically dispersed publication rates among the R01 grants. On average, publications produced by the research center grants had greater numbers of coauthors but similar journal impact factors compared with publications produced by the R01 grants. Conclusions: The lag in productivity among the transdisciplinary center grants was offset by their overall higher publication rates and average number of coauthors per publication, relative to investigator-initiated grants, over the 10-year comparison period. The findings suggest that transdisciplinary center grants create benefits for both scientific productivity and collaboration.

Prioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations

2012-02-01

Background: Delivery of preventive services sometimes falls short of guideline recommendations. Purpose: To evaluate the multilevel factors associated with evidence-based preventive service delivery during periodic health examinations (PHEs). Methods: Primary care physicians were recruited from an integrated delivery system in southeast Michigan. Audio recordings of PHE office visits conducted from 2007 to 2009 were used to ascertain physician recommendation for or delivery of 19 guideline-recommended preventive services. Alternating logistic regression was used to evaluate factors associated with service delivery. Data analyses were completed in 2011. Results: Among 484 PHE visits to 64 general internal medicine and family physicians by insured patients aged 50–80 years, there were 2662 services for which patients were due; 54% were recommended or delivered. Regression analyses indicated that the likelihood of service delivery decreased with patient age and with each concern the patient raised, and it increased with increasing BMI and with each additional minute after the scheduled appointment time the physician first presented. The likelihood was greater with patient–physician gender concordance and less if the physician used the electronic medical record in the exam room or had seen the patient in the past 12 months. Conclusions: A combination of patient, patient-physician relationship, and visit contextual factors are associated with preventive service delivery. Additional studies are warranted to understand the complex interplay of factors that support and compromise preventive service delivery.

A Conflict Between Nutritionally Adequate Diets and Meeting the 2010 Dietary Guidelines for Sodium

Matthieu Maillot, Adam Drewnowski — 2012-02-01

Background: Compliance with dietary guidelines means incorporating multiple foods and nutrients into everyday diets, to be consumed in smaller or larger amounts. Feasibility studies can help determine whether one nutrient guideline comes into conflict with another. For one half of the U.S. population, the 2010 dietary guidelines for sodium were set at 1500 mg/d. Purpose: To test the compatibility of the 1500 mg/day sodium goal with nutrient-adequate diets. Methods: Analyses, conducted in 2010, used U.S. federal nutrient composition and dietary intake databases to create modeled food patterns for six gender–age groups using linear programming techniques. The food patterns were designed to meet nutritional standards for 27 nutrients as the mean sodium content was progressively reduced from levels observed in the 2001–2002 National Health and Nutrition Examination Survey (NHANES) down to 1500 mg/day. Results: For adults aged <50 years, the 2300 mg/day sodium goal was consistent with nutrient-adequate diets but required large deviations from current eating patterns. The 1500 mg/day goal was not feasible and no mathematical solution was obtained. The lowest-sodium food patterns that were nutrient-adequate and theoretically achievable were very high in fruit juices, nuts, and seeds but were low in grains and meats. Conclusions: Compliance with the 2010 sodium guidelines will require large deviations from current eating behaviors and/or a profound modification of the U.S. food supply.

Physical Activity of Children Attending Afterschool Programs: Research- and Practice-Based Implications

2012-02-01

Background: Afterschool programs (3pm–6pm; ASPs) are positioned to play a vital role in the improvement of children's daily physical activity. Recent guidelines specify that children should accumulate 4600 steps per day while attending an ASP. The extent to which ASPs currently meet this goal and how many steps per day children naturally accumulate within the ASP setting is unknown. Purpose: The purpose of this study was to describe the pedometer-determined physical activity of a large sample of children attending a diverse range of ASPs and evaluate the extent to which ASPs are meeting current physical activity guidelines. Methods: Children (N=934, 51% girls, average 8.2 years; range 4–14 years) enrolled across 25 ASPs wore Walk4Life MVPa pedometers (number of steps accumulated, time spent active [hours:minutes:seconds]) up to 4 days. Data were collected in fall/spring 2010–2011 and analyzed in summer 2011. Results: On average, children attended ASPs for 125 minutes per day, accumulated 2944 steps per day, and spent approximately 26.6 minutes per day in physical activity. Only 16.5% of the 1819 daily observations met the 4600 steps per day guideline. No differences in steps per day, minutes per day in physical activity, or demographics were observed among children measured a single day versus 2, 3, or 4 days. Based on current practice, children would need to spend approximately 3.4 hours per day at an ASP to reach 4600 steps per day. Conclusions: Activity levels in ASPs are well below recommendations. Substantial effort is needed to identify strategies ASPs can employ to ensure children are sufficiently active.

External Validity Reporting in Behavioral Treatment of Childhood Obesity: A Systematic Review

2012-02-01

Context: To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity. Evidence acquisition: Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2–18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors. Evidence synthesis: 1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%–100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability. Conclusions: Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

Assessing the Built Environment Using Omnidirectional Imagery

2012-02-01

Observational audits commonly are used in public health research to collect data on built environment characteristics that affect health-related behaviors and outcomes, including physical activity and weight status. However, implementing in-person field audits can be expensive if observations are needed over large or geographically dispersed areas or at multiple points in time. A reliable and more efficient method for observational audits could facilitate extendibility (i.e., expanded geographic and temporal scope) and lead to more standardized assessment that strengthens the ability to compare results across different regions and studies. The purpose of the current study was to evaluate the degree of agreement between field audits and audits derived from interpretation of three types of omnidirectional imagery. Street segments from St. Louis MO and Indianapolis IN were stratified geographically to ensure representation of neighborhoods with different socioeconomic characteristics in both cities. Audits were conducted in 2008 and 2009 using four methods: field audits, and interpretation of archived imagery, new imagery, and Google Street View™ imagery. Agreement between field audits and image-based audits was assessed using observed agreement and the prevalence-adjusted bias-adjusted kappa statistic (PABAK). Data analysis was conducted in 2010. When measuring the agreement between field audits and audits from the different sources of imagery, the mean PABAK statistic for all items on the instrument was 0.78 (archived); 0.80 (new); and 0.81 (Street View imagery), indicating substantial to nearly perfect agreement among methods. It was determined that image-based audits represent a reliable method that can be used in place of field audits to measure several key characteristics of the built environment important to public health research.

Present and Future Horizons for Transdisciplinary Research

Barbara K. Rimer, David B. Abrams — 2012-02-01

In 1998, when one of us (BKR) presented the concept for Transdisciplinary Tobacco Use Research Centers (TTURCs) to the National Cancer Institute's (NCI's) Board of Scientific Advisors (BSA) for approval, they questioned whether transdisciplinary was a word. We provided the Oxford English Dictionary definition as proof. Fast-forward to 2008 when one of us (DBA), who was on the BSA and principal investigator for a TTURC, built on the NCI experience to make transdisciplinary systems science the centerpiece of the Office of Behavioral and Social Sciences Research's strategic plan for NIH institutes and centers. Recently, a Google search identified 809,000 hits for transdisciplinary research. Across NIH and beyond, globally, transdisciplinary is now part of research parlance and increasingly embraced as a mission-critical conceptual framework to address complex problems, from molecules to macroeconomics and from basic science to policy.

Editorial Board

2012-02-01

Assessing the Value of Team Science: A Study Comparing Center- and Investigator-Initiated Grants

2012-02-01

Assessing the Built Environment Using Omnidirectional Imagery

2012-02-01