Seo, Dong-Chul and Li, Kaigang

"Leisure-time physical activity dose-response effects on obesity among US adults: results from the 1999-2006 National Health and Nutrition Examination Survey"


Objective: To examine evidence for a dose-response relation of leisure-time physical activity (LTPA) with obesity in US adults.    Methods: Analyzed survey of 12227 non-institutionalized individuals, aged 20 through 64 years, drawn from the 8 years (1999-2006) of the continuous National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population.   Results: A crude graded inverse dose-response association was observed between LTPA and obesity among US adult women, not for men. The age-adjusted prevalence of women’s obesity was 41.4% for those with no LTPA in the past month; 39.1% for those who engaged in LTPA but fell short of the recommended minimum amount of LTPA (i.e., < 450 metabolic equivalent minutes per week); 31.0% for those who met the recommended minimum guideline (i.e., 450 to < 750); 28.0% for those whose LTPA exceeded the minimum guideline but less than the first quartile among the overachievers (i.e., 750 to < 1260); 23.4% for the overachievers between the first and third quartile (i.e., 1260 to < 3556); and 19.5% for the overachievers at or above the third quartile (i.e., 3556 or above). This association maintained even after occupational physical activity (OPA) was controlled. However, this pattern was not observed for Mexican and Black adults.   Conclusions: There is a dose-response relation between total volume of LTPA and obesity in US adult women. Gender and racial/ethnic differences exist in the relation of accumulated LTPA with obesity due, in part, to differential ratios of LTPA to OPA.      



Magidson, Jessica F., Hemberg Jordana L.,  La Touche Howard, Sylvette,

Gorka, Stephanie, Lejuez, C.W., and Daughters, Stacey B.

"Examining the effect of behavioral activation on

substance abuse treatment retention"


Depression is prevalent among substance users and has significant clinical implications, including substance abuse treatment dropout. Few interventions targeting depression have been developed to meet the specific needs of depressed, low-income substance users. One approach that has been suggested as useful in this context is behavioral activation (BA); Daughters and colleagues (2008) adapted BA to meet the specific needs of inner-city substance users with depression, and in a preliminary pilot study for this treatment [Life Enhancement Treatment for Substance Use (LET’S ACT)], LET’S ACT was associated with a significant reduction in depressive symptoms and a significant increase in reinforcement. The current study compared LET’S ACT to Supportive Counseling (SC) and examined the effect of treatment on substance abuse treatment retention among 58 low-income substance users with clinically significant depressive symptoms (BDI ≥ 12 or diagnosis of MDD) receiving residential substance abuse treatment in Washington, DC. Participants were assessed at baseline (week 0), post-treatment (week 4) and at a 2-week follow up (week 6). Intent-to-treat logistic regression analyses revealed that LET’S ACT significantly predicted dropout from residential treatment (OR = 11.74, CI = .009-.805, p < .05); 24% (n = 7) of individuals in SC dropped out of residential treatment and only 0.03% (n = 1) in LET’S ACT dropped out. Further, cox proportional hazards survival analyses indicated that SC was significantly associated with a shorter number of days to treatment dropout (hazards ratio = 10.49, CI = 1.27-86.86, p < .05). These findings provide initial evidence for the effect of LET’S ACT in reducing substance abuse treatment dropout, further suggesting utility in treating depression as a means to improve substance use outcomes.



Anstey, Erica H., Marhefka, Stephanie, Daley, Ellen, Vamos, Cheryl,

Kolar, Stephanie, Buhi, Eric, Giuliano, Anna

"Men’s disclosure of an HPV test result: An opportunity for educating women"


Purpose 1) Determine factors associated with men’s disclosure of Human Papillomavirus (HPV) test results to sexual partners. 2) Identify types of HPV-related information discussed with partners.   Methods Men participating in a psychosocial study of responses to HPV testing completed a computerized survey that included questions about HPV status, disclosure of HPV status and partner communication about other HPV-related information. Results from men with a main sexual partner were examined.   Results Men (n = 194; M age = 28.6 years, SD = 12.3) were primarily Caucasian (68%), non-Hispanic (81%), and had female partners (97%); most disclosed to their partner (81% total; 68% of HPV-positive; 89% of HPV-negative). In a multivariate logistic regression analysis, disclosure was 3.8 times more likely among HPV-negative men (OR=3.8; 95% CI=1.6-8.8), 1.3 times more likely among men who ranked their commitment to the main partner as 5 on a 5-point scale (5= totally committed; 1= not very committed), and 90% less likely among men with advanced degrees (vs. < high school diploma/GED; OR=0.1; 95% CI=0.02-0.7).  Disclosing men informed their partner that HPV: is sexually transmitted (60%); could be passed to them (58%); and causes genital warts (48%) and cervical cancer (49%).  Some suggested Pap smear screening (36%) or HPV vaccination (25%) to their partner.    Conclusions  Men were most likely to tell sexual partners their HPV status when they self-reported being HPV-negative. Among men who disclosed their HPV status, at least half provided partners with education about HPV. Assessing men’s reactions to HPV test results represents a unique opportunity for health educators to increase HPV knowledge and target prevention messages to women, as well. 


Cheney, Marshall K.; Oman, Roy F.; Vesely, Sara K; Aspy, Cheryl B.; Tolma, Eleni


"Negative life events and initiation of sexual intercourse in adolescents:

the influence of age, family structure, and family income"  


Background: Adolescents experiencing negative life events (NLEs) (e.g., problems in school) are at greater risk for adopting risk behaviors, but an association with initiation of sexual intercourse (ISI) has not been established. Methods:  Cross-sectional data were collected from 791 randomly-selected ethnically-diverse parents and their children (mean age= 14.3 years). Ten NLEs were examined and categorized into 0, 1, 2, and 3+ events. Data were stratified and analyzed by age, family structure and income.  Logistic regression was conducted with ISI as the outcome and NLEs as the independent variable.  Results: As age increased, the association of ISI with NLEs decreased and the association with income, ethnicity, and family structure increased. For example, for 13-14 year olds, NLEs were significantly associated with ISI (OR 29.4 for 3+ events) while for 15-16 year olds the OR was 4.7 for 3+ events. NLEs were significantly associated with ISI for both 1- and 2-parent households but the association was stronger for youth in one-parent households. For youth with a per capita family income below $10,000, negative events were significantly associated with ISI (OR 2.9 for 1 event and 5.6 for 3+ events). For youth with higher per capita family income, a decrease in family income from the previous year (OR 4.5) was significantly associated with ISI. Conclusions: Even one NLE is associated with increased risk of ISI. The relationship differs by age, family structure, and income, but the association was less pronounced for family structure.  Public Health Implications: Interventions to prevent ISI should focus on youth with a recent history of NLEs, particularly younger adolescents, regardless of family income and family structure.


Dubowitz, Tamara; Heron, Melonie; Basurto-Davila, Ricardo; Bird, Chloe E.; Escarce, Jose J.

"Decomposing racial/ethnic differences in health behaviors in the United States"


Background: Health behaviors can prevent or control chronic diseases, the leading cause of U.S. mortality, yet there are stark racial/ethnic differences in health behaviors and chronic disease incidence, prevalence, and mortality. Understanding how the effects on health behaviors of individual and neighborhood factors vary across racial/ethnic groups, and the contribution of such variations to disparities, could suggest ways to improve studies of health behaviors, as well as policy and interventions to improve them.  Methods: Using a regression-based Oaxaca decomposition analysis to a geocoded version of the Third National Health and Nutrition Examination Survey, we examined differences in diet, physical activity, smoking, and alcohol consumption among Non Hispanic (NH) Whites, NH Blacks, and Mexican-Americans.  Results: Both individual characteristics and neighborhood socioeconomic status contributed to racial/ethnic differences in health behaviors. Yet differential responses to individual characteristics and NSES contributed substantially to overall racial/ethnic differences in several health behaviors.  Conclusion: Our findings demonstrate that even if social and health policy were able to equalize individual characteristics and neighborhood SES across racial/ethnic groups,  we should expect that differences in health behaviors would narrow but some differences would be likely to persist.   Health interventions, particularly those that are directed at both the individual and neighborhood level, would benefit from tailored approaches and messages.  Observed characteristics are often the focus of policy recommendations in studies of health disparities (e.g., income transfers, educational interventions, or neighborhood improvements), but little, if any, attention has been given to the fact that reducing socioeconomic inequality may not eliminate disparities if there are differential responses to socioeconomic characteristics. 


Malo, Teri L.; Giuliano, Anna; Quinn, Gwen; Roetzheim, Richard; Bruder, Karen;

Lee, Ji-Hyun; Vadaparampil, Susan T.

"Physician perceptions of parental barriers to HPV vaccination among adolescent girls: A national survey"


Objective:  This study assessed the frequency with which physicians experience specific parental barriers to HPV vaccination, and examined the association between parental barriers and practice characteristics. Methods:  The American Medical Association Physician Masterfile was used to draw a nationally representative sample of primary care physicians (n=1738), including a subset of physicians specializing in Family Medicine and Pediatrics (n=1211) used in this study.  Participants completed a 38-item survey that included 11 items related to parental barriers.  A mean parental barrier score was obtained and dichotomized into “low” or “high” average barriers.  A Pearson chi-square test was used to estimate statistical significance between parental barriers and physician practice characteristics. Results:  The response rate was 68%, and 678 participants were included in the analyses.  The top five barriers that physicians reported they “always” or “often” experienced included lack of parent education/understanding about HPV infection (41.80%), parent concern about vaccine safety (37.76%), parent belief that child is not at risk for HPV infection (31.86%), parent request that HPV vaccination be deferred (31.71%), and parent reluctance to discuss sexuality/sexually transmitted infections (26.55%).  The odds of a low mean barrier score were higher for a Vaccines for Children (VFC) provider than for a non-VFC provider (OR = 1.38; 95% CI = 1.02 – 1.88), and for physicians who did not refer uninsured patients for HPV vaccination compared those who referred uninsured patients (OR = 1.36; 95% CI = 1.01 – 1.85). Conclusions:  Educational interventions for parents should focus on enhancing comprehension of HPV infection, including vaccine safety and the importance of vaccinating a child prior to the onset of sexual activity.  Interventions for physicians should focus on communicating sexuality issues with parents while minimizing discomfort with the topic.


Martinasek, Mary; Perrin, Kay; Mowat, Marisa; Hall, Melanie; Carouthers, Dewey

"An evaluation of a counter-marketing student-led campaign to decrease sedentary behavior

and fast food intake among 4th and 5th grade students"


Purpose: This study evaluated the effectiveness of a student-led counter-marketing campaign conducted during the school year with the primary aim of decreasing sedentary behaviors and fast food intake among 4th and 5th grade students.  The campaign is a peer-to-peer grassroots campaign aimed at educating children on the effects of over-consumption of fast food, soft drinks, and junk food and the deleterious effects of sedentary behaviors.  Methods:  A pre and post-test evaluation was conducted among principals (n=16), teachers (n=58), parents/guardians (n=1141), and students 2487) in sixteen schools. The 33-item survey measured opinion changes and behavioral changes before and after the student led campaign and adult perceptions of the effectiveness of the campaign on students’ achievement, self-esteem, and social interaction. Results: Students’ perceptions of fast food companies, soft drink companies, television networks, and video companies changed significantly after the campaign.  Video game playing and fast food consumption decreased and healthy snack consumption increased in the children.  Negative correlations were noted in children’s weight as related to parental physical fitness levels.  Conclusions:  The program was viewed by all intervention groups as being “cool” and as having a positive impact on the children.


Smith, Matthew L.; Ory, Marcia G.; Cheng, Yichen; Hochhalter, Angela K.

"Implementation and delivery of an evidence-based fall

prevention program for older adults in Texas"


While there is a recent emphasis on translational research, less evidence exists about how evidence-based health promotion programs are being implemented on larger scales. The purpose of this study is to describe the statewide dissemination of A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model utilizing the RE-AIM framework as a guide for planning and evaluation.  AMOB/VLL is an evidence-based falls prevention program for seniors designed to raise awareness of fall risk factors, introduce exercises for balance and strength, and empower informed choices about daily living.  In less than two years, over 2,700 seniors enrolled in the program, which is currently available in 239 of the 254 Texas counties.  Of the diverse participants reached, the majority of participants were age 75 years or older (59.4%), female (82.0%), non-Hispanic White (68.4%), and had one or more chronic illnesses (51.8%). When examining fidelity concerning ideal class sizes recommended by the original program developers (8-12 participants), 31.9% of the 198 classes conducted were within the ideal range, and 64.2% were larger than recommended (m=14.4, SD=4.18). In this Texas-wide rollout, 82.1% of enrolled seniors successfully completed the course having attended 5 or more of the 8 offered sessions (m=6.0, SD=2.0). No associations were found between class size and class completion rates (rho=0.015, p=0.528). Differences in participant characteristics and course completion by delivery site type will also be discussed.  Findings from this research have implications to inform program developers and delivery sites about ideal AMOB/VLL class sizes relative to maximum intervention benefits and cost efficiency.

The American Academy of Health Behavior