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Benitez TJ, Artigas E, Larsen B, Joseph RP, Pekmezi D, Marquez B, Whitworth JW, Marcus BH. Barriers and Facilitators to Muscle-Strengthening Activity Among Latinas in the U.S.: Results From Formative Research Assessments. Int J Behav Med 2024; 31:292-304. [PMID: 37231222 DOI: 10.1007/s12529-023-10183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Latinas are disproportionately affected by low physical activity (PA) levels and related health conditions (e.g., diabetes, obesity). Few Latinas in the U.S. (17%) meet the National PA Guidelines for both aerobic PA and muscle-strengthening activity (MSA), yet, research to date in this population has focused almost exclusively on aerobic PA. Performing regular MSA is linked with numerous health improvements and reduced mortality; thus, may be key to addressing health disparities in this community. This study examined perspectives on engaging in MSA among Latinas enrolled in two aerobic PA RCTs. METHODS Brief quantitative surveys were conducted to assess interest in MSA among Latinas (N = 81), along with 19 follow-up in-depth semi-structured interviews on knowledge, barriers, and facilitators for engaging in regular MSA. Interview transcripts were analyzed by two independent bilingual researchers using a directed content analysis approach. RESULTS Eighty-one Latinas (18-65 years) completed the survey. Most (91%) expressed interest in learning more about MSA and 60% reported not knowing how to do MSA as a substantial MSA barrier. Interview results indicated Latinas were aware of health benefits of MSA and motivated to engage in MSA but reported barriers (e.g., perception that MSA is for men, a taboo topic, and lack of knowledge on how to do MSA). CONCLUSION This study contributes to a critical gap in PA research among Latinas. Findings will inform future culturally appropriate MSA interventions in this at-risk population. Addressing MSA and aerobic PA together in future interventions will provide a more comprehensive approach to reducing PA-related health disparities in Latinas than aerobic PA alone.
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Affiliation(s)
- Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.
| | - Eileen Artigas
- Center for Health Communication, University of Texas at Austin, Austin, TX, USA
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Rodney P Joseph
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Becky Marquez
- Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - James W Whitworth
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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von Ash T, Dunsiger SI, Williams DM, Larsen BA, Bohlen LC, Pekmezi D, Mendoza-Vasconez AS, Benitez TJ, Bock BC, Hartman SJ, Marquez B, Marcus BH. Pasos Hacia La Salud II: A Superiority RCT Utilizing Technology to Promote Physical Activity in Latinas. Am J Prev Med 2024:S0749-3797(24)00085-0. [PMID: 38490284 DOI: 10.1016/j.amepre.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Latinas face an increased risk for chronic diseases associated with insufficient physical activity (PA). The researchers previously showed that a website-based intervention could increase PA among insufficiently active Latinas, yet rates of meeting national PA guidelines were low. The original intervention was enhanced by adding additional features, content, and points of contact, including via text messaging. This study tests the efficacy of the enhanced intervention compared with the original, aimed at maximizing and sustaining PA gains across 24 months. It also examines if increases in PA differed by baseline PA. STUDY DESIGN The researchers conducted a superiority randomized controlled trial (data collected 2018-2022, analyzed 2023). SETTING/PARTICIPANTS Participants were 195 Spanish-speaking Latinas ages 18-65 in the Providence, RI area. INTERVENTION The original intervention is an empirically supported Spanish-language, individually-tailored, website-delivered PA intervention. The enhanced intervention includes text messaging and additional data-driven content and interactive features. MAIN OUTCOME MEASURES Total weekly minutes of moderate to vigorous PA (MVPA) was measured via accelerometry and self-report at 6, 12, 18, and 24 months. RESULTS Participants in both groups increased their MVPA over 24 months. There were no significant between-group differences at 6 or 12 months; at 18 months the enhanced intervention group had higher levels of self-reported (mean (sd): 90.35 (43.55) vs 70.18 [9.99]) and accelerometer-measured (66.21 [18.26] vs 60.27 [16.00]) MVPA compared to the original intervention group. They also had higher levels of self-reported (111.17 [23.35] vs 81.44 [1.82]) and accelerometer-measured (63.76 [15.12] vs 54.86 [14.59]) MVPA at 24 months. Baseline PA moderated the intervention effect. CONCLUSIONS This study demonstrates the potential to enhance the efficacy of website-based PA interventions by utilizing text messaging, and adding more interactive features, content, and phone support. These enhancements may be particularly beneficial in supporting long-term PA maintenance. TRIAL REGISTRATION This study is registered at www. CLINICALTRIAL gov (NCT03491592).
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Affiliation(s)
- Tayla von Ash
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island.
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Lauren Connell Bohlen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Dori Pekmezi
- Department of Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
| | - Beth C Bock
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Becky Marquez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island; Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
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Pekmezi D, Dunsiger S, Benitez T, Larsen B, Vasconez AM, Marcus B. Improvements in stress among Latinas participating in a randomized controlled trial of technology-supported physical activity interventions. Stress Health 2024:e3374. [PMID: 38289870 DOI: 10.1002/smi.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
High levels of stress and inactivity likely contribute to chronic disease disparities among Latinas in the U.S. and call for intervention. To inform such efforts, the current study examined the relationships among changes (over time) in physical activity, stress, and related cardiometabolic biomarkers among sedentary (mostly) first generation Latinas. Data are taken from a randomized controlled trial (N = 199 Latinas) of two home-based physical activity interventions (Original vs. theory- and technology- Enhanced versions). Physical activity and perceived stress were assessed at baseline and 6 and 12 months. Blood draws occurred at baseline and 6 months in a random subsample (N = 153). The participants were underactive (<60/min week of moderate-to-vigorous physical activity) Mexican American (89%) women with moderate perceived stress scores (M = 21.49, SD = 8.55, range = 0-40) and excess weight (M BMI = 30.6) at baseline. Overall, participants reported decreases in stress after 6 months enroled in the physical activity programs. The odds of a reduction in perceived stress were 11% higher among Enhanced versus Original Intervention participants (OR = 1.11, 95% CI: 1.05-2.27). Those who met physical activity guidelines were significantly more likely to report reductions in perceived stress over 6 months (OR = 1.92, 95% CI: 1.08-4.16). Furthermore, those who reported reductions in perceived stress over 6 months reported significantly more moderate-to-vigorous physical activity at 12 months (+69 min/week, SE = 27.98, p = 0.01) compared to those who did not. Greater reductions in perceived stress over 6 months were associated with greater improvements in cardiometabolic biomarkers (HbA1c, triglycerides, p's < 0.05). These results support a bidirectional relationship between improvements in stress and physical activity among Latinas. Future implications include using physical activity to address stress management and health disparities in this community.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, California, USA
| | - Andrea Mendoza Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Bess Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
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Larsen B, Gilmer T, Pekmezi D, Hartman SJ, Benitez T, Rabin B, Marcus BH, Mendoza-Vasconez AS, Groessl EJ. Cost effectiveness of a technology-enhanced physical activity intervention for Latinas. Transl Behav Med 2023; 13:675-682. [PMID: 37208924 PMCID: PMC10496433 DOI: 10.1093/tbm/ibad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Latinas report low levels of physical activity (PA) and disproportionate risk of lifestyle-related diseases. Enhancements to evidence-based PA interventions may increase efficacy; however, uptake of interventions will likely depend on costs. To describe costs and examine the cost-effectiveness of two interventions for helping Latinas reach national aerobic PA guidelines. Adult Latinas (N = 199) were randomly assigned to an Original theory-based mail-delivered intervention or an Enhanced version with texting and additional calls and materials. Meeting PA guidelines was measured by the 7-Day PA Recall interview at baseline, 6 and 12 months. Intervention costs were estimated from a payer perspective. Incremental cost-effectiveness ratios (ICERs) were calculated as the additional cost per participant meeting guidelines in the Enhanced versus Original intervention. At baseline, no participants met guidelines. After 6 months, 57% and 44% in the Enhanced and Original arms met guidelines, respectively; at 12 months, rates fell to 46% and 36%. Cost per person of the Enhanced and Original interventions were $184 and $173 at 6 months, respectively, and $234 and $203 at 12 months. The primary additional expense in the Enhanced arm was staff time. ICERs were $87 per additional person meeting guidelines at 6 months (per sensitivity analysis, $26 if delivered by volunteers and $114 by medical assistants), and $317 at 12 months (sensitivity analysis: $57 and $434). Incremental costs per person meeting guidelines in the Enhanced arm were modest and could be warranted given the potential health benefits of meeting PA guidelines.
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Affiliation(s)
- Britta Larsen
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Todd Gilmer
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, AL, USA
| | - Sheri J Hartman
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Tanya Benitez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Borsika Rabin
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, San Diego, CA, USA
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Erik J Groessl
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
- Health Services Research and Development unit, VA San Diego Health Care System, San Diego, CA, USA
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Brown NI, Stewart L, Rogers LQ, Anne Powell M, Hardy CM, Baskin ML, Oster RA, Pisu M, Demark-Wahnefried W, Pekmezi D. Assessing the built environment, programs, and policies that support physical activity opportunities in the rural Deep South. Prev Med Rep 2023; 33:102223. [PMID: 37223566 PMCID: PMC10201820 DOI: 10.1016/j.pmedr.2023.102223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Disparities in physical activity (PA) exist in rural regions and prior research suggests environmental features and community resources likely contribute. It is important to identify the opportunities and barriers that influence activity to appropriately inform PA interventions in such areas. Thus, we assessed the built environment, programs and policies related to PA opportunity in six rural Alabama counties that were purposively selected to inform a PA randomized controlled trial. Assessments were conducted August 2020-May 2021 using the Rural Active Living Assessment. Town characteristics and recreational amenities were captured using the Town Wide Assessment (TWA). PA programs and policies were examined with the Program and Policy Assessment. Walkability was evaluated using the Street Segment Assessment (SSA). Using the scoring system (0-100), the overall TWA score was 49.67 (range: 22-73), indicating few schools within walking distance (≤5 miles of the town's center) and town-wide amenities (e.g., trails, water/recreational activities) for PA. The Program and Policy Assessment showed a paucity of programming and guidelines to support activity (overall average score of 24.67, [range: 22-73]). Only one county had a policy requiring walkways/bikeways in new public infrastructure projects. During assessment of 96 street segments, few pedestrian-friendly safety features [sidewalks (32%), crosswalks (19%), crossing signals (2%), and public lighting (21%)] were observed. Limited opportunities for PA (parks and playgrounds) were identified. Barriers such as few policies and safety features (crossing signals, speed bumps) were indicated as factors that should be addressed when developing PA interventions and informing future policy efforts.
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Affiliation(s)
- Nashira I. Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Stewart
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q. Rogers
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Anne Powell
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Claudia M. Hardy
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L. Baskin
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Oster
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
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Rogers LQ, Pekmezi D, Schoenberger-Godwin YM, Fontaine KR, Ivankova NV, Kinsey AW, Hoenemeyer T, Martin MY, Pisu M, Farrell D, Wall J, Waugaman K, Oster RA, Kenzik K, Winters-Stone K, Demark-Wahnefried W. Using the TIDieR checklist to describe development and integration of a web-based intervention promoting healthy eating and regular exercise among older cancer survivors. Digit Health 2023; 9:20552076231182805. [PMID: 37434730 PMCID: PMC10331096 DOI: 10.1177/20552076231182805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective To facilitate replication and future intervention design of web-based multibehavior lifestyle interventions, we describe the rationale, development, and content of the AiM, Plan, and act on LIFestYles (AMPLIFY) Survivor Health intervention which provides healthy eating and exercise behavior change support for older cancer survivors. The intervention promotes weight loss, improvements in diet quality, and meeting exercise recommendations. Methods The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a comprehensive description of the AMPLIFY intervention, consistent with CONSORT recommendations. Results A social cognitive theory web-based intervention founded on the core components of efficacious print and in-person interventions was conceptualized and developed through an iterative collaboration involving cancer survivors, web design experts, and a multidisciplinary investigative team. The intervention includes the AMPLIFY website, text and/or email messaging, and a private Facebook group. The website consists of: (1) Sessions (weekly interactive e-learning tutorials); (2) My Progress (logging current behavior, receiving feedback, setting goals); (3) Tools (additional information and resources); (4) Support (social support resources, frequently asked questions); and (5) Home page. Algorithms were used to generate fresh content daily and weekly, tailor information, and personalize goal recommendations. An a priori rubric was used to facilitate intervention delivery as healthy eating only (24 weeks), exercise only (24 weeks), or both behaviors concurrently over 48 weeks. Conclusions Our TIDieR-guided AMPLIFY description provides pragmatic information helpful for researchers designing multibehavior web-based interventions and enhances potential opportunities to improve such interventions.
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Affiliation(s)
- Laura Q. Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Yu-Mei Schoenberger-Godwin
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R. Fontaine
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA, USA
| | - Nataliya V. Ivankova
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amber W. Kinsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y. Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maria Pisu
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Kaitlyn Waugaman
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Oster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Williams VA, Brown NI, Johnson R, Ainsworth MC, Farrell D, Barnes M, Perumean-Chaney S, Fontaine K, Martin MY, Pekmezi D, Demark-Wahnefried W. A Web-based Lifestyle Intervention for Cancer Survivors: Feasibility and Acceptability of SurvivorSHINE. J Cancer Educ 2022; 37:1773-1781. [PMID: 34061334 PMCID: PMC8633161 DOI: 10.1007/s13187-021-02026-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/05/2023]
Abstract
Assess the feasibility, acceptability, and preliminary efficacy of a healthy lifestyle website, SurvivorSHINE ( www.survivorshine.org ), for cancer survivors using a mixed-methods approach. Formative research included a comprehensive literature review and four focus groups on website preferences with diagnosis-diverse cancer survivors (N = 17). Their feedback informed a web adaptation of a telephone counseling and mailed-print lifestyle intervention previously found effective for cancer survivors. The resulting web-based intervention was examined in a 3-week, single-arm trial among 41 cancer survivors. Assessments of physical activity, diet, body weight, and knowledge related to exercise and diet guidelines for cancer survivors occurred at baseline and 3 weeks later, along with exit interviews. Themes from focus groups indicated cancer survivors' desire for easy-to-use, interactive web-based platforms to access credible diet and exercise information. The study sample was recruited within 12 months, and study retention was high (85.4%). Participants showed significant pre- to post-test improvements in diet and exercise knowledge (t = 5.31, p < .0001) and physical activity (t = 2.40, p = .02). Improvements in body weight and some dietary components (red meat, alcohol) were observed, but did not reach statistical significance. Results support the feasibility and acceptability of SurvivorSHINE. The significant increases in healthy lifestyle knowledge and physical activity found in the current study are promising, but a larger, randomized-controlled trial is needed to determine efficacy.
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Affiliation(s)
- Victoria A Williams
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Nashira I Brown
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Roman Johnson
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - M Cole Ainsworth
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | | | | | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, USA
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Pekmezi D, Motl R. Targeting Physical Inactivity Using Behavioral Theory in Chronic, Disabling Diseases. Exerc Sport Sci Rev 2022; 50:156-161. [PMID: 35522244 DOI: 10.1249/jes.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Physical inactivity and comorbidities (e.g., hypertension) result in poor prognoses among persons with chronic, disabling conditions including multiple sclerosis, Parkinson disease, and stroke. Theory can guide the design of behavior change interventions that can be delivered remotely for broad scale implementation. We hypothesize that theory-based behavior change interventions can increase physical activity and reduce comorbidities and associated consequences among persons with chronic, disabling conditions.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL
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Benitez TJ, Dunsiger S, Marquez B, Larsen B, Pekmezi D, Marcus BH. Increases in Muscle-Strengthening Activities Among Latinas in Seamos Saludables. Health Educ Behav 2022; 49:446-454. [PMID: 35227112 DOI: 10.1177/10901981221074908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Only 17% of Latinas meet national physical activity (PA) guidelines for both moderate-to-vigorous aerobic and muscle-strengthening PA. Additional health benefits are derived from the combination of aerobic and muscle-strengthening PA (vs. aerobic alone), yet there is paucity in research on muscle-strengthening activity in Latinas. The aim of this study was to examine changes in muscle-strengthening activity from baseline to 6 and 12 months in Seamos Saludables, a 12-month PA randomized controlled trial for Latinas. METHODS A secondary data analysis was conducted among 131 Latinas ages 18-65 years, who were randomized to either a PA Intervention or a Wellness Control. Self-reported muscle-strengthening exercise was measured at baseline, 6 months, and 12 months via adapted muscle-strengthening questions from the Behavioral Risk Factor Surveillance System. RESULTS There was a 16-minute/week difference in median minute/week of muscle-strengthening activity between Intervention and Wellness at 6 months (SE = 7.91, p = .04) and 45-minute/week difference at 12 months (SE = 25.80, p = .06) adjusting for baseline. Significantly more PA Intervention participants met muscle-strengthening guidelines of 2 or more days/week at 6 months versus Wellness Control participants (odds ratio [OR] = 4.29, 95% confidence interval [CI] = [1.03, 17.84]). CONCLUSION Results from the current study showed that Latinas engaged in muscle-strengthening activity in an intervention that emphasized primarily aerobic PA outcomes, suggesting they may be interested in engaging in muscle-strengthening activities. Future interventions targeting both aerobic and muscle-strengthening activity could achieve greater health improvements and help more Latinas reach the full national PA guidelines.ClinicalTrials.gov Identifier. NCT01583140.
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Affiliation(s)
- Tanya J Benitez
- Brown University School of Public Health, Providence, RI, USA
| | - Shira Dunsiger
- Brown University School of Public Health, Providence, RI, USA
| | - Becky Marquez
- University of California San Diego, La Jolla, CA, USA
| | - Britta Larsen
- University of California San Diego, La Jolla, CA, USA
| | - Dori Pekmezi
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bess H Marcus
- Brown University School of Public Health, Providence, RI, USA
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Pekmezi D, Fontaine K, Rogers LQ, Pisu M, Martin MY, Schoenberger-Godwin YM, Oster RA, Kenzik K, Ivankova NV, Demark-Wahnefried W. Adapting MultiPLe behavior Interventions that eFfectively Improve (AMPLIFI) cancer survivor health: program project protocols for remote lifestyle intervention and assessment in 3 inter-related randomized controlled trials among survivors of obesity-related cancers. BMC Cancer 2022; 22:471. [PMID: 35488238 PMCID: PMC9051494 DOI: 10.1186/s12885-022-09519-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scalable, multiple behavior change interventions are needed to address poor diet, inactivity, and excess adiposity among the rising number of cancer survivors. Efficacy-tested diet (RENEW) and exercise (BEAT Cancer) programs were adapted for web delivery among middle-aged and older cancer survivors for the AMPLIFI study, a National Cancer Institute-funded, multi-site, program project. METHODS Throughout the continental U.S., survivors of several obesity-related cancers are being recruited for three interconnected randomized controlled trials (RCTs). Projects 1 and 2 test 6-month diet or exercise interventions versus a wait-list control condition. Upon completion of the 6-month study period, the intervention participants receive the next behavior change sequence (i.e., diet receives exercise, exercise receives diet) and the wait-list control arm initiates a 12-month combined diet and exercise intervention. Project 3 tests the efficacy of the sequential versus simultaneous interventions. Assessments occur at baseline and semi-annually for up to 2-years and include: body mass index, health behaviors (diet quality, accelerometry-assessed physical activity/sleep), waist circumference, D3 creatine-assessed muscle mass, physical performance, potential mediators/moderators of treatment efficacy, biomarkers of inflammation and metabolic regulation, health care utilization, cost, and overall health. Four shared resources support AMPLIFI RCTs: 1) Administrative; 2) Adaptation, Dissemination and Implementation; 3) Recruitment and Retention; and 4) Assessment and Analysis. DISCUSSION Representing a new generation of RCTs, AMPLIFI will exclusively use remote technologies to recruit, intervene and assess the efficacy of the newly-adapted, web-based diet and exercise interventions and determine whether sequential or combined delivery works best for at-risk (older, rural, racial minority) cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov , NCT04000880 . Registered 27 June 2019.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA.
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yu-Mei Schoenberger-Godwin
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | - Kelly Kenzik
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Medicine, UAB, Birmingham, AL, USA
| | | | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
- Department of Nutrition Sciences, UAB, Birmingham, AL, USA
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Williams V, Brown N, Moore JX, Farrell D, Perumean-Chaney S, Schleicher E, Fontaine K, Demark-Wahnefried W, Pekmezi D. Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study. JMIR Form Res 2022; 6:e30974. [PMID: 35188468 PMCID: PMC8902653 DOI: 10.2196/30974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. OBJECTIVE The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. METHODS A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants' gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann-Whitney U tests were used to compare demographic factors on website use. RESULTS Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). CONCLUSIONS Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity.
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Affiliation(s)
- Victoria Williams
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nashira Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin Xavier Moore
- Department of Population Health Sciences, Augusta University, Augusta, GA, United States
| | | | - Suzanne Perumean-Chaney
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kevin Fontaine
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
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Thirumalai M, Brown N, Niranjan S, Townsend S, Powell MA, Neal W, Schleicher E, Raparla V, Oster R, Demark-Wahnefried W, Pekmezi D. An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study. JMIR Hum Factors 2022; 9:e29494. [PMID: 34982714 PMCID: PMC8767466 DOI: 10.2196/29494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/29/2021] [Accepted: 09/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. OBJECTIVE The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. METHODS A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. RESULTS The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. CONCLUSIONS The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.
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Affiliation(s)
- Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Nashira Brown
- Department of Nutrition Sciences, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Soumya Niranjan
- Department of Health Services Administration, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Sh'Nese Townsend
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Anne Powell
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Whitney Neal
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Erica Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Venkatadri Raparla
- University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert Oster
- Division of Preventive Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, School of Health Professions, University of Birmingham at Alabama, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Marcus BH, Larsen BA, Linke SE, Hartman SJ, Pekmezi D, Benitez T, Sallis J, Mendoza-Vasconez AS, Dunsiger SI. Long-term physical activity outcomes in the Seamos Activas II trial. Prev Med Rep 2021; 24:101628. [PMID: 34976681 PMCID: PMC8684003 DOI: 10.1016/j.pmedr.2021.101628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 10/27/2022] Open
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14
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Pisu M, Omairi I, Hoenemeyer T, Halilova KI, Schoenberger YMM, Rogers LQ, Kenzik KM, Oster RA, Ivankova NV, Pekmezi D, Fontaine K, Demark-Wahnefried W, Martin MY. Developing a virtual assessment protocol for the AMPLIFI Randomized Controlled Trial due to COVID-19: From assessing participants' preference to preparing the team. Contemp Clin Trials 2021; 111:106604. [PMID: 34757221 PMCID: PMC8555106 DOI: 10.1016/j.cct.2021.106604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/01/2022]
Abstract
Background During the COVID-19 pandemic, in-person research assessments needed to be adapted to ensure safety of participants and staff. Participants' willingness to participate in research activities, how to prepare assessors to ensure data integrity, and the feasibility of modified protocols, were unknown. Within the AMPLIFI randomized clinical trial (RCT) for cancer survivors, we elicited participants' preferences and willingness to participate in Clinic, Home, or Virtual assessments, prepared assessors for, and implemented virtual assessments. Methods 1) We conducted phone surveys of potential AMPLIFI participants; 2) Based on survey results, we modified assessments from in-person to virtual visits (VV) by videoconference. Assessors were trained and certified, i.e., assessors recorded 3 assessments that were reviewed and scored by 2 investigators. The modified protocol was proposed to 62 participants: we report numbers of those who agreed to attend VV. Results 1) Survey results: Among 74 survey respondents, 44.6% preferred, 75.7% were willing to attend Clinic Visits; 32.4% preferred, 83.8% were willing to do VV; 23% preferred, 77% were willing to do Home Visits. Survivors 70+ were less likely than 50-69 years old to be willing to do VV: no other differences were noted by gender, race, rural status or education. 2) Assessment uptake: 66.1% agreed to attend VV, and of them 75.6% completed them. Conclusion Diverse research participants adapted to protocols that prioritize their safety, although older participants may be reluctant to do virtual assessments. Virtual assessments are feasible and research teams can rigorously prepare to collect quality data through them.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Iman Omairi
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Teri Hoenemeyer
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karina I Halilova
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yu-Mei M Schoenberger
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laura Q Rogers
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kelly M Kenzik
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Hematology & Oncology, University of Alabama at Birmingham, Birmingham, AL, USA; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A Oster
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nataliya V Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dori Pekmezi
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Kevin Fontaine
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Y Martin
- Center for Innovation in Health Equity Research, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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15
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Pekmezi D, Cadmus-Bertram L, Lewis B. Perspectives on the benefits of leadership training for career growth among three mid-career behavioral scientists. Transl Behav Med 2021; 10:896-901. [PMID: 33030534 PMCID: PMC8502424 DOI: 10.1093/tbm/ibaa061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Participation in the Society of Behavioral Medicine (SBM) Mid-Career Leadership Institute was invaluable in navigating challenges and opportunities experienced by behavioral scientists at key mid-career transitions. Professionals are expected to take on more responsibilities at mid-career, often with minimal guidance and/or relevant training in the requisite leadership skills. The SBM Leadership Institute provided concrete practical strategies for managing time, work email, planning/goal setting, and conflict resolution. The purpose of this commentary is to review the impact of the SBM Leadership Institute on new leadership roles obtained by three SBM Leadership Fellows. Practices adopted as a result of the Leadership Institute will be discussed (e.g., right sizing the workload, "inbox zero," starting with priority work, and single tasking). The use of these strategies resulted in increased productivity and reduced work stress. Furthermore, one-on-one executive career coaching and participation in our learning community cultivated the direct, effective communication skills needed to take on new leadership roles/projects (e.g., transitioning to department chair, running for SBM board, launching ACSM Exercise is Medicine On Campus program). The leadership projects helped to push Fellows out of their comfort zones and provided excellent opportunities for networking and increased involvement in organizations and professional societies. In sum, the SBM Leadership Institute helped instill the confidence and focus needed to surmount midcareer obstacles and accelerate into the next career phase.
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Affiliation(s)
- Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, USA
| | | | - Beth Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, USA
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16
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Brown NI, Powell MA, Baskin M, Oster R, Demark-Wahnefried W, Hardy C, Pisu M, Thirumalai M, Townsend S, Neal WN, Rogers LQ, Pekmezi D. Design and Rationale for the Deep South Interactive Voice Response System-Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e29245. [PMID: 34032575 PMCID: PMC8188314 DOI: 10.2196/29245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region's lower rates of literacy and internet access, interactive voice response (IVR) system-automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System-Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties. OBJECTIVE This paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System-Supported Active Lifestyle intervention. METHODS A two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System-Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity-related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O'Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts. RESULTS This study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County. CONCLUSIONS IVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region. TRIAL REGISTRATION ClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29245.
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Affiliation(s)
- Nashira I Brown
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mary Anne Powell
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Monica Baskin
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Robert Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Claudia Hardy
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Maria Pisu
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sh'Nese Townsend
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Whitney N Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Laura Q Rogers
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
- O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL, United States
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Larsen B, Dunsiger SI, Pekmezi D, Linke S, Hartman SJ, Marcus BH. Psychosocial mediators of physical activity change in a web-based intervention for Latinas. Health Psychol 2020; 40:21-29. [PMID: 33370154 DOI: 10.1037/hea0001041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: To determine whether psychosocial constructs targeted in an online physical activity intervention for Latinas mediated changes in moderate-to-vigorous physical activity (MVPA). Method: Data were taken from a randomized trial of a web-based MVPA intervention for Latina women age 18-65 (N = 205) based on social cognitive theory and the transtheoretical model. Baseline and 6-month measures included minutes/week of MVPA (ActiGraph GT3X + accelerometers and 7-Day Physical Activity Recall Interview) and theorized mediators (self-efficacy, behavioral processes, cognitive processes, social support, enjoyment). A multiple mediation model adjusting for baseline MVPA was fit using a products of coefficients method, simultaneously testing all hypothesized mediators. Results: MVPA increased more in the intervention group than controls by 50 min/week (self-report) and 31 min/week (accelerometers). For the self-reported MVPA model, there was an intervention effect (a-path coefficient) on self-efficacy (b = 0.43, p < .01), cognitive processes (b = 0.64, p < .01), behavioral processes (b = 0.54, p < .01), and enjoyment (b = 9.91, p = .01). Changes in self-efficacy (b = 24.54, p = .03), social support from friends (b = 2.36, p = .04), and enjoyment (a = 0.74, p = .08) were associated with changes in MVPA (b-path coefficient). However, only changes in self-efficacy (b = 10.49, 95% CI [2.46, 24.54]) and enjoyment (b = 7.30, 95% CI [0.92, 21.78]) mediated the intervention effect on MVPA (ab-path coefficient). For the accelerometer-measured MVPA model, intervention effects were significant for self-efficacy (b = 0.48, p < .01), cognitive processes (b = 0.62, p < .01), and behavioral processes (b = 0.61, p < .01), yet only self-efficacy was associated with changes in MVPA (b = 4.43, p = .03), and mediated intervention effects on MVPA (b = 12.15, 95% CI [11.25, 16.34]). Conclusions: Future MVPA interventions with Latinas should target self-efficacy and enjoyment to maximize efficacy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, School of Public Health, Brown University
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham
| | - Sarah Linke
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
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Cardel MI, Dhurandhar E, Yarar-Fisher C, Foster M, Hidalgo B, McClure LA, Pagoto S, Brown N, Pekmezi D, Sharafeldin N, Willig AL, Angelini C. Turning Chutes into Ladders for Women Faculty: A Review and Roadmap for Equity in Academia. J Womens Health (Larchmt) 2020; 29:721-733. [PMID: 32043918 DOI: 10.1089/jwh.2019.8027] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite significant progress in recent decades, the recruitment, advancement, and promotion of women in academia remain low. Women represent a large portion of the talent pool in academia, and receive >50% of all PhDs, but this has not yet translated into sustained representation in faculty and leadership positions. Research indicates that women encounter numerous "chutes" that remove them from academia or provide setbacks to promotion at all stages of their careers. These include the perception that women are less competent and their outputs of lesser quality, implicit bias in teaching evaluations and grant funding decisions, and lower citation rates. This review aims to (1) synthesize the "chutes" that impede the careers of women faculty, and (2) provide feasible recommendations, or "ladders" for addressing these issues at all career levels. Enacting policies that function as "ladders" rather than "chutes" for academic women is essential to even the playing field, achieve gender equity, and foster economic, societal, and cultural benefits of academia.
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Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics and Pediatrics, University of Florida, Gainesville, Florida
| | - Emily Dhurandhar
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Ceren Yarar-Fisher
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Monica Foster
- Department of Nutrition Sciences, University of Florida, Gainesville, Florida
| | - Bertha Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Nathanial Brown
- Department of Mathematics, Penn State University, State College, Pennsylvania
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama
| | - Noha Sharafeldin
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amanda L Willig
- Department of Medicine, Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine Angelini
- Department of Environmental Engineering Sciences, Environmental School for Sustainable Infrastructure and the Environment (ESSIE), University of Florida, Gainesville, Florida
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Linke SE, Dunsiger SI, Gans KM, Hartman SJ, Pekmezi D, Larsen BA, Mendoza-Vasconez AS, Marcus BH. Association Between Physical Activity Intervention Website Use and Physical Activity Levels Among Spanish-Speaking Latinas: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13063. [PMID: 31342902 PMCID: PMC6685130 DOI: 10.2196/13063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 01/24/2023] Open
Abstract
Background The internet’s low cost and potential for high reach makes Web-based channels prime for delivering evidence-based physical activity (PA) interventions. Despite the well-studied success of internet-based PA interventions in primarily non-Hispanic white populations, evidence on Spanish-speaking Latinas’ use of such interventions is lacking. The recent rise in technology use among Latinas in the United States, a population at heightened risk for low PA levels and related conditions, suggests that they may benefit from Web-based PA interventions tailored to their cultural and language preferences. Objective The goal of the research was to examine participant engagement with various features of an internet-based PA intervention for Latinas and explore how use of these features was differentially associated with adoption and maintenance of PA behavior change. Method Pasos Hacia la Salud tested a Spanish-language, culturally adapted, individually tailored, internet-based PA intervention versus a Spanish language, internet-based, Wellness Contact Control condition for underactive Latinas (N=205, mean age 39.2 [SD 10.5] years, 84% Mexican American). These analyses examined engagement with the website and explored how use was associated with adoption and maintenance of moderate to vigorous physical activity (MVPA) behavior. Results Overall, participants logged on to the website an average of 22 times (SD 28) over 12 months, with intervention participants logging on significantly more than controls (29 vs 14.7, P<.001). On average, participants spent more time on the website at months 1, 4, and 6 compared to all other months, with maximum use at month 4. Both log-ins and time spent on the website were significantly related to intervention success (achieving higher mean minutes of MVPA per week at follow-up: b=.48, SE 0.20, P=.02 for objectively measured MVPA and b=.74, SE 0.34, P=.03 for self-reported MVPA at 12 months, controlling for baseline). Furthermore, those meeting guidelines by the Centers for Disease Control and Prevention for PA at 12 months (≥150 minutes per week of MVPA) logged on significantly more than those not meeting guidelines (35 vs 20 over 12 months, P=.002). Among participants in the intervention arm, goal-setting features, personal PA reports, and PA tips were the most used portions of the website. Higher use of these features was associated with greater success in the program (significantly more minutes of self-reported MVPA at 12 months controlling for baseline). Specifically, one additional use of these features per month over 12 months translated into an additional 34 minutes per week of MVPA (goals feature), 12 minutes per week (PA tips), and 42 minutes per week (PA reports). Conclusions These results demonstrate that greater use of a tailored, Web-based PA intervention, particularly certain features on the site, was significantly related to increased PA levels in Latinas. Trial Registration ClinicalTrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287
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Affiliation(s)
- Sarah E Linke
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital and Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Kim M Gans
- Department of Human Development and Family Studies, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States.,Department of Behavioral and Social Sciences and the Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, United States
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, AL, United States
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Andrea S Mendoza-Vasconez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States
| | - Bess H Marcus
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital and Warren Alpert Medical School, Brown University, Providence, RI, United States.,Department of Behavioral and Social Sciences and the Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, United States
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Ainsworth MC, Perumean-Chaney SE, Fontaine KR, Thirumalai M, Rogers LQ, Pekmezi D. Sedentary Adult Characteristics and Exercise Benefits and Barriers: Associations in an Interactive Voice Response Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562665.77048.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pekmezi D, Ainsworth C, Desmond R, Pisu M, Williams V, Wang K, Holly T, Meneses K, Marcus B, Demark-Wahnefried W. Physical Activity Maintenance Following Home-Based, Individually Tailored Print Interventions for African American Women. Health Promot Pract 2018; 21:268-276. [PMID: 30203677 PMCID: PMC8258802 DOI: 10.1177/1524839918798819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women report low participation in physical activity and are disproportionately burdened by related conditions (obesity, breast, and colon cancer). Physical activity interventions have shown promising results among African American women, but most studies in this area have focused on short-term increases. More enduring changes in health behavior will be needed to eliminate existing health disparities. Thus, the current study examined 12-month physical activity and psychosocial outcomes from a pilot randomized controlled trial (N = 84) of a Home-based Individually tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. Retention was 77.4% at 12 months. HIPP participants increased self-reported moderate-to-vigorous physical activity from 35.1 minutes/week (standard deviation [SD] = 47.8) at baseline to 124 minutes/week (SD = 95.5) at 12 months, compared with the wellness contact control participants who reported increases from 48.2 minutes/week (SD = 51.3) to 102.5 minutes/week (SD = 94.5) over 12 months (between-group p > .05). Results indicate that modest improvements in moderate-to-vigorous physical activity and related psychosocial variables occurred during the active intervention phase (months 0-6) and were sustained during the tapered maintenance period (months 6-12). Low-cost, high-reach, home-based strategies have great potential for supporting sustained participation in physical activity and achieving long-term health benefits among African American women in the Deep South.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cole Ainsworth
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Renee Desmond
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Kaiying Wang
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Taylor Holly
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- University of Alabama at Birmingham, Birmingham, AL, USA
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Pekmezi D, Ainsworth C, Holly T, Williams V, Joseph R, Wang K, Rogers LQ, Marcus B, Desmond R, Demark-Wahnefried W. Physical Activity and Related Psychosocial Outcomes From a Pilot Randomized Trial of an Interactive Voice Response System-Supported Intervention in the Deep South. Health Educ Behav 2018; 45:957-966. [PMID: 29884069 PMCID: PMC7457542 DOI: 10.1177/1090198118775492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical activity exerts cancer-protective effects, yet most Americans are inactive, especially in the South, where cancer incidence rates are generally higher. Telephone-based approaches can help overcome physical activity intervention barriers in this region (literacy, costs, lack of transportation/technology, distance from facilities) and can be automated via interactive voice response (IVR) systems for improved reach and cost-effectiveness. AIMS To evaluate the Deep South IVR-supported Active Lifestyle (DIAL) intervention. METHOD A pilot randomized controlled trial was conducted among 63 underactive adults in Birmingham, Alabama, from 2015 to 2017. RESULTS Retention was 88.9% at 12 weeks, and ≥75% adherence (IVR contact on at least 63 out of 84 days) was noted among 62.5% of intervention participants. Intervention participants reported larger increases in self-reported minutes of moderate-to-vigorous intensity physical activity from baseline to 12 weeks than the wait-list control arm (median change = 47.5 vs. 5.0 minutes, respectively, p = .09). Moreover, the intervention produced significantly greater increases in physical activity self-regulation ( p < .001) and social support from family ( p = .001) and friends ( p = .009) from baseline to 12 weeks, compared with the wait-list control. Significant decreases in self-reported sleep disturbance also were found in the intervention arm but not among the controls, p < .05. Overall, intervention participants reported being satisfied with the DIAL program (71.4%) and would recommend it to friends (92.9%). DISCUSSION Findings support the feasibility, acceptability, and preliminary efficacy of the DIAL intervention. CONCLUSION Next steps include intervention refinement in preparation for a fully powered efficacy trial and eventual dissemination to rural counties.
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Ainsworth MC, Pekmezi D, Bowles H, Ehlers D, McAuley E, Courneya KS, Rogers LQ. Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study. JMIR Cancer 2018; 4:e9. [PMID: 29759953 PMCID: PMC5972204 DOI: 10.2196/cancer.8951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/19/2018] [Accepted: 03/16/2018] [Indexed: 12/16/2022] Open
Abstract
Background Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods Acceptability data were collected from participants (N=40; 100% response rate) using a self-administered survey after 5 days of Life in a Day use. Results Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60%, 24/40) or overly time-consuming (68%, 27/40). Life in a Day was rated as easy to read (88%, 35/40) and navigate (70%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90%, 35/39). Only 13% (5/40) downloaded the app on their personal phone, whereas 63% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X)
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Affiliation(s)
- Matthew Cole Ainsworth
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Dori Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Heather Bowles
- National Cancer Institute, Division of Cancer Prevention, Bethesda, MD, United States
| | - Diane Ehlers
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Laura Q Rogers
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
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Pekmezi D, Ainsworth C, Holly T, Williams V, Benitez T, Wang K, Rogers LQ, Marcus B, Demark-Wahnefried W. Rationale, design, and baseline findings from a pilot randomized trial of an IVR-Supported physical activity intervention for cancer prevention in the Deep South: the DIAL study. Contemp Clin Trials Commun 2018; 8:218-226. [PMID: 29503878 PMCID: PMC5830176 DOI: 10.1016/j.conctc.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Telephone-delivered interventions do not require frequent clinic visits, literacy, or costly technology and thus may represent promising approaches to promoting physical activity in the Deep South, a largely rural U.S. region, with generally lower physical activity, income, and education levels. Building on past Interactive Voice Response (IVR) system-based HIV studies and extensive formative research (11 focus groups on physical activity intervention needs/preferences in the Deep South), the resulting IVR-supported physical activity intervention is now being tested in a randomized controlled trial with a waitlist control. The sample (n=63) includes mostly obese (Mean BMI=30.1) adults (Mean age=43 years) in Birmingham, AL. Both genders (55.6% male) and African Americans (58.7%) are well-represented. Most participants reported at least some college (92%), full time employment (63.5%), and household income <$50,000 per year (61.9%). Baseline physical activity (Mean=39.6 minutes/week, SD=56.4), self-efficacy, self-regulation, and social support were low. However, high physical activity enjoyment and outcome expectations bode well. Self-report physical activity was associated with physical activity enjoyment (r=.36) and social support (friends r=.25, p's<.05) at baseline. Consequently, these may be important variables to emphasize in our program. Depression and anxiety were negatively correlated with some early indicators of behavior change (e.g., physical activity self-regulation; r's =-.43 and -.46, respectively, p's<.01) and thus may require additional attention. Such technology-supported strategies have great potential to reach underserved populations and address physical activity-related health disparities in this region.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Cole Ainsworth
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Taylor Holly
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Victoria Williams
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Tanya Benitez
- University of California, San Diego, 9500 Gilman Drive, 0628, La Jolla, CA. 92093-0628
| | - Kaiying Wang
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Laura Q Rogers
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL, US 35294
| | - Bess Marcus
- Brown University, 121 S Main St, Providence, RI 02903
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Pekmezi D, Ainsworth C, Joseph RP, Williams V, Desmond R, Meneses K, Marcus B, Demark-Wahnefried W. Pilot Trial of a Home-based Physical Activity Program for African American Women. Med Sci Sports Exerc 2018; 49:2528-2536. [PMID: 28704343 DOI: 10.1249/mss.0000000000001370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aimed to assess the feasibility of a Home-based, Individually-tailored Physical activity Print (HIPP) intervention for African American women in the Deep South. METHODS A pilot randomized trial of the HIPP intervention (N = 43) versus wellness contact control (N = 41) was conducted. Recruitment, retention, and adherence were examined, along with physical activity (7-d physical activity recalls, accelerometers) and related psychosocial variables at baseline and 6 months. RESULTS The sample included 84 overweight/obese African American women 50-69 yr old in Birmingham, AL. Retention was high at 6 months (90%). Most participants reported being satisfied with the HIPP program and finding it helpful (91.67%). There were no significant between-group differences in physical activity (P = 0.22); however, HIPP participants reported larger increases (mean of +73.9 min·wk (SD 90.9)) in moderate-intensity or greater physical activity from baseline to 6 months compared with the control group (+41.5 min·wk (64.4)). The HIPP group also reported significantly greater improvements in physical activity goal setting (P = 0.02) and enjoyment (P = 0.04) from baseline to 6 months compared with the control group. There were no other significant between-group differences (6-min walk test, weight, physical activity planning, behavioral processes, stage of change); however, trends in the data for cognitive processes, self-efficacy, outcome expectations, and family support for physical activity indicated small improvements for HIPP participants (P > 0.05) and declines for control participants. Significant decreases in decisional balance (P = 0.01) and friend support (P = 0.03) from baseline to 6 months were observed in the control arm and not the intervention arm. CONCLUSIONS The HIPP intervention has great potential as a low-cost, high-reach method for reducing physical activity-related health disparities. The lack of improvement in some domains may indicate that additional resources are needed to help this target population reach national guidelines.
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Affiliation(s)
- Dori Pekmezi
- 1School of Public Health, University of Alabama at Birmingham, Birmingham, AL; 2College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; 3Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL; 4School of Nursing, University of Alabama at Birmingham, Birmingham, AL; 5School of Public Health, Brown University, Providence, RI; and 6Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
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Larsen B, Marcus B, Pekmezi D, Hartman S, Gilmer T. A Web-Based Physical Activity Intervention for Spanish-Speaking Latinas: A Costs and Cost-Effectiveness Analysis. J Med Internet Res 2017; 19:e43. [PMID: 28228368 PMCID: PMC5343212 DOI: 10.2196/jmir.6257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/21/2016] [Accepted: 01/14/2017] [Indexed: 11/14/2022] Open
Abstract
Background Latinas report particularly low levels of physical activity and suffer from greater rates of lifestyle-related conditions such as obesity and diabetes. Interventions are needed that can increase physical activity in this growing population in a large-scale, cost-effective manner. Web-based interventions may have potential given the increase in Internet use among Latinas and the scalability of Web-based programs. Objective To examine the costs and cost-effectiveness of a Web-based, Spanish-language physical activity intervention for Latinas compared to a wellness contact control. Methods Healthy adult Latina women (N=205) were recruited from the community and randomly assigned to receive a Spanish-language, Web-based, individually tailored physical activity intervention (intervention group) or were given access to a website with content on wellness topics other than physical activity (control group). Physical activity was measured using the 7-Day Physical Activity Recall interview and ActiGraph accelerometers at baseline, 6 months (ie, postintervention), and 12 months (ie, maintenance phase). Costs were estimated from a payer perspective and included all features necessary to implement the intervention in a community setting, including staff time (ie, wages, benefits, and overhead), materials, hardware, website hosting, and routine website maintenance. Results At 6 months, the costs of running the intervention and control groups were US $17 and US $8 per person per month, respectively. These costs fell to US $12 and US $6 per person per month at 12 months, respectively. Linear interpolation showed that intervention participants increased their physical activity by 1362 total minutes at 6 months (523 minutes by accelerometer) compared to 715 minutes for control participants (186 minutes by accelerometer). At 6 months, each minute increase in physical activity for the intervention group cost US $0.08 (US $0.20 by accelerometer) compared to US $0.07 for control participants (US $0.26 by accelerometer). Incremental cost-per-minute increases associated with the intervention were US $0.08 at 6 months and US $0.04 at 12 months (US $0.16 and US $0.08 by accelerometer, respectively). Sensitivity analyses showed variations in staffing costs or intervention effectiveness yielded only modest changes in incremental costs. Conclusions While the Web-based physical activity intervention was more expensive than the wellness control, both were quite low cost compared to face-to-face or mail-delivered interventions. Cost-effectiveness ranged markedly based on physical activity measure and was similar between the two conditions. Overall, the Web-based intervention was effective and low cost, suggesting a promising channel for increasing physical activity on a large scale in this at-risk population. ClinicalTrial Clinicaltrials.gov NCT01834287; https://clinicaltrials.gov/ct2/show/NCT01834287 (Archived by WebCite at http://www.webcitation.org/6nyjX9Jrh)
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Affiliation(s)
- Britta Larsen
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States
| | - Bess Marcus
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States
| | - Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sheri Hartman
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States
| | - Todd Gilmer
- University of California, San Diego, Department of Family Medicine and Public Health, La Jolla, CA, United States
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Joseph RP, Daniel CL, Thind H, Benitez TJ, Pekmezi D. Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors. Am J Lifestyle Med 2016; 10:356-368. [PMID: 28217036 PMCID: PMC5313056 DOI: 10.1177/1559827614554594] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/17/2022] Open
Abstract
Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.
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Affiliation(s)
- Rodney P. Joseph
- Rodney P. Joseph, PhD, College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ 85004; e-mail:
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Marquez B, Dunsiger SI, Pekmezi D, Larsen BA, Marcus BH. Social support and physical activity change in Latinas: Results from the Seamos Saludables trial. Health Psychol 2016; 35:1392-1401. [PMID: 27669178 DOI: 10.1037/hea0000421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Family responsibilities and poor social support are barriers to physical activity among Latinas. This study evaluated the effects of a home- and print-based intervention on social support, moderating effects of familial ties on support and moderate-to-vigorous physical activity (MVPA), and mediating effects of support on MVPA. METHOD Participants were randomized to receive through the mail either individually tailored physical activity intervention or general wellness print materials. Familial ties and social support were assessed by marital and child status and the social support for physical activity measure, respectively. MVPA was measured using the 7-day Physical Activity Recall Interview and accelerometer. Assessments were conducted at baseline, 6 months posttreatment, and 12 months follow-up. RESULTS Participants (n = 266; 40.6 ± 9.9 years old) were mostly immigrant and Spanish-speaking Latinas. The intervention group achieved greater increases in family and friend support compared to the wellness control group from baseline to posttreatment and follow-up (p < .05). Intervention changes in support did not depend on marital or child status. The intervention also increased minutes per week of MVPA more than the wellness control (p < .05) and the effect did not depend on marital or child status. There were significant indirect effects of treatment, indicating the intervention achieved greater increases in MVPA by increasing family (ab = 5.21, SE = 2.94, 95% confidence interval [CI] = 0.91-14.11) and friend (ab = 6.83, SE = 5.15, 95% CI = 0.16-20.56) support. CONCLUSIONS The intervention improved and sustained support from family and friends and MVPA irrespective of familial ties. Social support mediated increases in MVPA. (PsycINFO Database Record
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Affiliation(s)
| | - Shira I Dunsiger
- of Psychiatry & Human Behavior, Miriam Hospital, Brown University
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama
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Mendoza-Vasconez AS, Linke S, Muñoz M, Pekmezi D, Ainsworth C, Cano M, Williams V, Marcus BH, Larsen BA. Promoting Physical Activity among Underserved Populations. Curr Sports Med Rep 2016; 15:290-7. [PMID: 27399827 PMCID: PMC5371027 DOI: 10.1249/jsr.0000000000000276] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations.
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- 1 Department of Family Medicine and Public Health, University of California, La Jolla, CA; 2 Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Marcus BH, Hartman SJ, Larsen BA, Pekmezi D, Dunsiger SI, Linke S, Marquez B, Gans KM, Bock BC, Mendoza-Vasconez AS, Noble ML, Rojas C. Pasos Hacia La Salud: a randomized controlled trial of an internet-delivered physical activity intervention for Latinas. Int J Behav Nutr Phys Act 2016; 13:62. [PMID: 27234302 PMCID: PMC4884436 DOI: 10.1186/s12966-016-0385-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/14/2016] [Indexed: 11/29/2022] Open
Abstract
Background Internet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention. Methods Inactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego. Results Increases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p < 0.01). Increases in objectively measured MVPA were also significantly larger in the Intervention Group (mean differences = 31.0, SE = 10.7, p < .01). The Intervention Group was also significantly more likely to meet national physical activity guidelines at 6 months (OR = 3.12, 95 % CI 1.46–6.66, p < .05). Conclusion Findings from the current study suggest that this Internet-delivered individually tailored intervention successfully increased MVPA in Latinas compared to a Wellness Contact Control Internet Group. Trial registration NCT01834287.
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Affiliation(s)
- Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA.
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, RI and Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Sarah Linke
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Becky Marquez
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Kim M Gans
- Department of Behavioral and Social Sciences and the Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital, Providence, RI and Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Andrea S Mendoza-Vasconez
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Madison L Noble
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
| | - Carlos Rojas
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0628, USA
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Pekmezi D, Ainsworth C, Joseph R, Bray MS, Kvale E, Isaac S, Desmond R, Meneses K, Marcus B, Demark-Wahnefried W. Rationale, design, and baseline findings from HIPP: A randomized controlled trial testing a home-based, individually-tailored physical activity print intervention for African American women in the Deep South. Contemp Clin Trials 2016; 47:340-8. [PMID: 26944022 PMCID: PMC4821007 DOI: 10.1016/j.cct.2016.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
African American women report high rates of physical inactivity and related health disparities. In our previous formative research, we conducted a series of qualitative assessments to examine physical activity barriers and intervention preferences among African American women in the Deep South. These data were used to inform a 12-month Home-based, Individually-tailored Physical activity Print (HIPP) intervention, which is currently being evaluated against a wellness contact control condition among 84 post-menopausal African American women residing in the metropolitan area of Birmingham, Alabama. This paper reports the rationale, design and baseline findings of the HIPP trial. The accrued participants had an average age of 57 (SD=4.7), a BMI of 32.1 kg/m(2) (SD=5.16) with more than half (55%) having a college education and an annual household income under $50,000 (53.6%). At baseline, participants reported an average of 41.5 min/week (SD=49.7) of moderate intensity physical activity, and 94.1% were in the contemplation or preparation stages of readiness for physical activity. While social support for exercise from friends and family was low, baseline levels of self-efficacy, cognitive and behavioral processes of change, decisional balance, outcome expectations, and enjoyment appeared promising. Baseline data indicated high rates of obesity and low levels of physical activity, providing strong evidence of need for intervention. Moreover, scores on psychosocial measures suggested that such efforts may be well received. This line of research in technology-based approaches for promoting physical activity in African American women in the Deep South has great potential to address health disparities and impact public health.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States.
| | - Cole Ainsworth
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
| | - Rodney Joseph
- Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004, United States
| | - Molly S Bray
- University of Texas at Austin, 103 W. 24th Street, Austin, TX 78712, United States
| | - Elizabeth Kvale
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
| | - Shiney Isaac
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
| | - Renee Desmond
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
| | - Karen Meneses
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
| | - Bess Marcus
- University of California, San Diego, 9500 Gilman Drive, 0628, La Jolla, CA 92093-0628, United States
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham, 1665 University Blvd., Birmingham, AL US 35294, United States
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Larsen B, Gilmer T, Pekmezi D, Napolitano MA, Marcus BH. Cost effectiveness of a mail-delivered individually tailored physical activity intervention for Latinas vs. a mailed contact control. Int J Behav Nutr Phys Act 2015; 12:140. [PMID: 26559336 PMCID: PMC4642691 DOI: 10.1186/s12966-015-0302-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 10/30/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Physical inactivity is high in Latinas, as are chronic health conditions. There is a need for physical activity (PA) interventions that are not only effective but have potential for cost-effective widespread dissemination. The purpose of this paper was to assess the costs and cost effectiveness of a Spanish-language print-based mail-delivered PA intervention that was linguistically and culturally adapted for Latinas. METHODS Adult Latinas (N = 266) were randomly assigned to receive mail-delivered individually tailored intervention materials or wellness information mailed on the same schedule (control). PA was assessed at baseline, six months (post-intervention) and 12 months (maintenance phase) using the 7-Day Physical Activity Recall Interview. Costs were calculated from a payer perspective, and included personnel time (wage, fringe, and overhead), materials, equipment, software, and postage costs. RESULTS At six months, the PA intervention cost $29/person/month, compared to $15/person/month for wellness control. These costs fell to $17 and $9 at 12 months, respectively. Intervention participants increased their PA by an average of 72 min/week at six months and 94 min/week at 12 months, while wellness control participants increased their PA by an average of 30 min/week and 40 min/week, respectively. At six months, each minute increase in PA cost $0.18 in the intervention group compared to $0.23 in wellness control, which fell to $0.07 and $0.08 at 12 months, respectively. The incremental cost per increase in physical activity associated with the intervention was $0.15 at 6 months and $0.05 at 12 months. CONCLUSIONS While the intervention was more costly than the wellness control, costs per minute of increase in PA were lower in the intervention. The print-based mail-delivered format has potential for broad, cost-effective dissemination, which could help address disparities in this at-risk population. TRIAL REGISTRATION NCT01583140; Date of Registration: 03/06/2012; Funding Source of Trial: National Institute of Nursing Research (NINR); Name of Institutional Review Board: Brown University IRB; Date of Approval: 05/19/2009.
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Affiliation(s)
- Britta Larsen
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
| | - Todd Gilmer
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama, Birmingham, USA.
| | - Melissa A Napolitano
- Departments of Prevention and Community Health & Exercise and Nutrition Sciences, The George Washington University School of Public Health, ., ..
| | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Dr, San Diego, CA, 92093-0628, USA.
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Marcus BH, Hartman SJ, Pekmezi D, Dunsiger SI, Linke SE, Marquez B, Gans KM, Bock BC, Larsen BA, Rojas C. Using interactive Internet technology to promote physical activity in Latinas: Rationale, design, and baseline findings of Pasos Hacia La Salud. Contemp Clin Trials 2015; 44:149-158. [PMID: 26255237 DOI: 10.1016/j.cct.2015.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/31/2015] [Accepted: 08/03/2015] [Indexed: 11/26/2022]
Abstract
Internet-based interventions show promise as an effective channel for promoting physical activity. However, a paucity of research has been conducted among underserved groups despite recent increases in Internet access and physical activity-related health disparities in these communities. Thus, the current randomized controlled trial will test the efficacy of an individually tailored, Internet-based physical activity intervention for Latinas. This program was culturally and linguistically adapted for the target population through extensive formative research. Two hundred eighteen sedentary Latinas were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. The Physical Activity Internet Intervention, based on Social Cognitive Theory and the Transtheoretical Model, utilizes a website with features including self-monitoring, goal setting, discussion forum, links to online resources, individually tailored and motivation-matched physical activity feedback reports, and exercise tip sheets. Participants receive regular emails over the first 6months with a tapered dose during the second 6months (maintenance phase) to alert them to new content on the website. The main outcome is differences in minutes/week of moderate to vigorous physical activity at six months as measured by the 7-Day Physical Activity Recall and accelerometer data. High reach, low cost, culturally relevant Internet-based interventions that encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.
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Affiliation(s)
- Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, AL, United States.
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States; The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, United States.
| | - Sarah E Linke
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Becky Marquez
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Kim M Gans
- Department of Human Development and Family Studies, Center for Health Interventions and Prevention, University of Connecticut, United States; Institute for Community Health Promotion, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States.
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States; The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, United States.
| | - Britta A Larsen
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
| | - Carlos Rojas
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States.
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Larsen B, Gilmer T, Pekmezi D, Napolitano M, Marcus B. Cost-effectiveness Of A Mail-delivered Culturally And Linguistically Adapted Physical Activity Intervention For Latinas. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477534.11767.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Marcus BH, Dunsiger SI, Pekmezi D, Larsen BA, Marquez B, Bock BC, Gans KM, Morrow KM, Tilkemeier P. Twelve-month physical activity outcomes in Latinas in the Seamos Saludables trial. Am J Prev Med 2015; 48:179-182. [PMID: 25442225 PMCID: PMC5718346 DOI: 10.1016/j.amepre.2014.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/03/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical activity interventions designed for Latinas have shown short-term behavior change, but longer-term change and maintenance is rarely measured. PURPOSE To assess physical activity change at 12 months, following 6-month tapered completion of an RCT of a physical activity intervention for Latinas. METHODS Two hundred sixty-six underactive (<60 minutes/week physical activity) Latinas were randomized to an individually tailored, culturally and linguistically adapted physical activity intervention, or a wellness contact control. Participants received the materials through the mail for 6 months, then received booster doses at 8, 10, and 12 months. Minutes per week of moderate to vigorous physical activity were measured by the 7-Day Physical Activity Recall interview at baseline and 6 and 12 months. Data were collected at Brown University between 2009 and 2013, and analyses were conducted in 2013. RESULTS At 12 months, increases in moderate to vigorous physical activity were significantly greater in the intervention than in the wellness group (mean difference=52 minutes/week, SE=9.38, p<0.01), with both groups showing slight increases in moderate to vigorous physical activity from 6 to 12 months. Intervention participants were also more likely to meet national moderate to vigorous physical activity guidelines (OR=3.14, p=0.01). CONCLUSIONS The intervention was more effective than the wellness control at 12 months, and physical activity increases from baseline to 6 months were maintained, suggesting the intervention may lead to sustainable behavior change. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov NCT01583140.
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Affiliation(s)
- Bess H Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, California.
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Britta A Larsen
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Becky Marquez
- Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kim M Gans
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kathleen M Morrow
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter Tilkemeier
- Centers for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Miriam Hospital; Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Joseph RP, Pekmezi D, Dutton GR, Cherrington AL, Kim YI, Allison JJ, Durant NH. Results of a Culturally Adapted Internet-Enhanced Physical Activity Pilot Intervention for Overweight and Obese Young Adult African American Women. J Transcult Nurs 2014; 27:136-46. [PMID: 24934566 DOI: 10.1177/1043659614539176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study evaluated a culturally relevant, social cognitive theory-based, Internet-enhanced physical activity (PA) pilot intervention developed for overweight/obese African American (AA) female college students. DESIGN Using a 3-month, single group, pretest-posttest design, participants accessed a culturally relevant PA promotion website and engaged in four moderate-intensity PA sessions each week. RESULTS Study completers (n = 25, mean age = 21.9 years) reported a decrease in sedentary screen time (p < .0001); however, no changes in moderate-to-vigorous PA were reported (p = .150). A significant increase in self-regulation for PA (p < .0001) and marginally significant increases in social support (p = .052) and outcome expectations (p = .057) for PA were observed. No changes in body mass index (p = .162), PA enjoyment (p = .151), or exercise self-efficacy (p = .086) were reported. CONCLUSIONS Findings of this exploratory study show some preliminary support for Internet-enhanced approaches to promote PA among overweight/obese AA women. IMPLICATIONS FOR PRACTICE Future studies with larger samples are needed to further explore culturally relevant Internet-enhanced PA programs in this underserved population.
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Affiliation(s)
| | - Dori Pekmezi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Young-Il Kim
- University of Alabama at Birmingham, Birmingham, AL, USA
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Pekmezi D, Dunsiger S, Marquez B, Larsen B, Bock B, Gans K, Marcus B. Potential Theoretical Mechanisms Of Action Related To Physical Activity (pa) Behavior Change In Latinas. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000494014.76175.a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pekmezi D, Marcus B, Meneses K, Baskin ML, Ard JD, Martin MY, Adams N, Robinson C, Demark-Wahnefried W. Developing an intervention to address physical activity barriers for African-American women in the deep south (USA). ACTA ACUST UNITED AC 2013; 9:301-12. [PMID: 23638785 DOI: 10.2217/whe.13.20] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To address high rates of inactivity and related chronic diseases among African-American women. MATERIALS & METHODS Eleven focus groups on physical activity barriers for African-American women in the deep south (USA) were conducted (n = 56). Feedback guided an intervention development process. The resulting Home-Based Individually Tailored Physical Activity Print intervention was vetted with the target population in a 1-month, single arm, pre-post test demonstration trial (n = 10). RESULTS Retention was high (90%). Intent-to-treat analyses indicated increases in motivational readiness for physical activity (70% of sample) and physical activity (7-day Physical Activity Recall) from baseline (mean: 89.5 min/week, standard deviation: 61.17) to 1 month (mean: 155 min/week, standard deviation: 100.86). Small improvements in fitness (6-Min Walk Test), weight and psychosocial process measures were also found. CONCLUSION Preliminary findings show promise and call for future randomized controlled trials with larger samples to determine efficacy. Such low-cost, high-reach approaches to promoting physical activity have great potential for addressing health disparities and benefiting public health.
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Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham, 1665 University Boulevard, 227 RPHB Birmingham, AL 35293, USA.
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Pekmezi D, Martin MY, Kvale E, Meneses K, Demark-Wahnefried W. Enhancing Exercise Adherence for the Breast Cancer Survivors. ACSMs Health Fit J 2012; 16:8-13. [PMID: 23275740 DOI: 10.1249/fit.0b013e31825a6db6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Dori Pekmezi
- University of Alabama at Birmingham 1665 University Blvd., 227 RPHB Birmingham, AL 35293 205-975-8061
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Abstract
This article provides a review of health promotion research conducted among Latinos. The authors examined 31 intervention studies promoting physical activity and/or healthy diet in Latino samples. Overall, findings suggested that Latinos are responsive to interventions promoting physical activity and healthy diet, despite facing numerous barriers to health promotion. In fact, 12 of the 21 studies that measured physical activity and 19 of the 26 studies that measured dietary behavior reported that the intervention produced significant improvements in those health behaviors. Design strengths of these studies included the high rates of retention and large number of randomized controlled trials. However, there were concerns regarding the lack of diversity in the samples (mostly Mexican American women), limiting the generalizability of the findings and the underutilization of objective measures of physical activity and diet behavior in intervention studies.
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Affiliation(s)
- Dori Pekmezi
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island,
| | - Becky Marquez
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
| | - Joshua Marcus-Blank
- Medical School of Brown University, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
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Abstract
This article provides a summary of recent physical activity intervention research conducted among African Americans. As prior reviews have been published in this area, the authors updated the literature by focusing on the past 8 years. Overall, there has been an increase in the number and methodological rigor of the studies in this area. Thirty studies published in peer-reviewed journals were included in the current review. Results from 18 of these studies indicated that interventions produced significant increases in activity behavior among African American participants. Recent improvements in this research include larger sample sizes, more randomized controlled trials, and increased use of reliable and valid self-report measures, objective assessment tools, and theoretical backgrounds for interventions. However, attrition and long-term exercise adherence remain problematic in this area of research.
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Affiliation(s)
- Dori Pekmezi
- Miriam Hospital and Brown Medical School, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island,
| | - Ernestine Jennings
- Miriam Hospital and Brown Medical School, Centers for Behavioral and Preventive Medicine, Providence, Rhode Island
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