Background The “Positive Action for Today’s Health” (PATH) trial tested an environmental intervention to increase walking in underserved communities. Methods Three matched communities were randomized to a police-patrolled walking plus social marketing, a police-patrolled walking-only, or a no-walking intervention. The 24-month intervention addressed safety and access for physical activity (PA) and utilized social marketing to enhance environmental supports for PA. African-Americans (N=434; 62 % females; aged 51±16 years) provided accelerometry and psychosocial measures at baseline and 12, 18, and 24 months. Walking attendance and trail use were obtained over 24 months. Results There were no significant differences across communities over 24 months for moderate-to-vigorous PA. Walking attendance in the social marketing community showed an increase from 40 to 400 walkers per month at 9 months and sustained ~200 walkers per month through 24 months. No change in attendance was observed in the walking-only community. Conclusions Findings support integrating social marketing strategies to increase walking in underserved African-Americans (ClinicalTrials.gov #NCT01025726).
Background The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. Design and setting The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11–16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M+FWL (Motivational Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M+FWL vs. CHE group) × 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. Intervention The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback.
Background Few previous studies have examined the influence of instrumental and emotional social support on physical activity (PA) longitudinally in underserved adolescents. Purpose This longitudinal study was a secondary analysis of the Active by Choice Today (ACT) trial examining whether instrumental social support predicts increases in PA in underserved adolescents, above and beyond emotional social support provided by family or peers. Methods Students in 6th grade (N=1422, 73% African American, 54% female, Mage=11 years) in the ACT trial participated. At baseline and 19 weeks, previously validated measures of social support (family instrumental, family emotional, and peer emotional) were completed and moderate-to-vigorous PA (MVPA) was assessed using 7-day accelerometry estimates. Results A mixed ANCOVA demonstrated that baseline (p=.02) and change in family instrumental support (p=.01), but not emotional support from family or peers, predicted increases in MVPA across a 19-week period. Conclusions Future interventions in underserved adolescents should enhance opportunities for instrumental support for PA.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, and its symptoms and impairment in multiple domains begin in childhood and can extend into adulthood as well. Many youth with ADHD experience impairment in the social domain, including social skills deficits and difficulties in peer relationships. Social skills interventions, or social skills training (SST), have been developed to target social impairment and improve the social skills and functioning of youth with ADHD. Previous reviews of SST for youth with ADHD have provided mixed conclusions, with many including comprehensive, multilevel interventions for ADHD and none examining stand-alone SST for ADHD in a systematic way. The present review addresses this gap in the literature by providing the first known comprehensive, systematic review of SST alone, along with ratings of methodological rigor for each evaluation of stand-alone SST. The present review provides insight into the strengths and weaknesses in the existing SST literature, and provides suggestions for improvement and future directions for SST. An outline of "specific ingredients" and characteristics of effective SST are also presented, with the goal of providing both researchers and clinicians guidance for creating and implementing effective SST for youth with ADHD.
Objective African Americans have the highest rates of obesity in the United States. Engaging in recommended levels of physical activity (PA) reduces risk for obesity. Social and environmental supports for PA may be important to increase PA. This study hypothesized that PA would mediate the effects of neighborhood and social supports for PA on body mass index (BMI). Method Baseline data were collected from 434 underserved African American adults in the Positive Action for Today’s Health (PATH) trial. Features of the neighborhood environment (i.e., infrastructure for walking, access to services, and crime) and peer social support were measured with validated surveys. Moderate-to-vigorous PA (MVPA) was assessed based on 7-day accelerometry estimates (in minutes per day), and self-reported walking and exercise were obtained using the Four-Week Physical Activity History questionnaire. Results The sample was predominantly female (63%) and obese (MBMI = 30.88 kg/m2, SD = 8.43). Neither crime nor social support was significantly associated with either PA or BMI; thus, they were excluded from the final models. Infrastructure for walking predicted MVPA (B = 4.06, p = .01) and self-reported walking (B = 7.39, p = .03). A positive association between access to services and MVPA approached significance (B = 2.27, p = .06). MVPA (B = −0.07, p < .001) and self-reported walking (B = −0.02, p = .01) predicted BMI, but only MVPA mediated the effect of infrastructure for walking on BMI (B = −0.03, p = .04). No significant direct or indirect effects of predictors were found for self-reported exercise. Conclusion Findings suggest that MVPA is a mediator linking infrastructure for walking and BMI in underserved communities.
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