IntroductionHealth disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity–related policy and environmental strategies for obesity prevention in rural communities.MethodsA literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity–related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.ResultsOf 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were “enhance infrastructure supporting walking” (n = 11) and “increase opportunities for extracurricular physical activity” (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.ConclusionSeven of the 12 COCOMO physical activity–related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.
The purpose of the present investigation was to conduct a meta-analysis of the literature on examiner errors for the Wechsler scales of intelligence. Results indicate that a mean of 99.7% of protocols contained at least 1 examiner error when studies that included a failure to record examinee responses as an error were combined and a mean of 41.2% of protocols contained at least 1 examiner error when studies that ignored errors of omission were combined. Furthermore, graduate student examiners were significantly more likely to make at least 1 error on Wechsler intelligence test protocols than psychologists. However, psychologists made significantly more errors per protocol than graduate student examiners regardless of the inclusion or exclusion of failure to record examinee responses as errors. On average, 73.1% of Full-Scale IQ (FSIQ) scores changed as a result of examiner errors, whereas 15.8%-77.3% of scores on the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index changed as a result of examiner errors. In addition, results suggest that examiners tend to overestimate FSIQ scores and underestimate VCI scores. However, no strong pattern emerged for the PRI and WMI. It can be concluded that examiner errors occur frequently and impact index and FSIQ scores. Consequently, current estimates for the standard error of measurement of popular IQ tests may not adequately capture the variance due to the examiner.
Future studies should incorporate higher levels of theoretical application, and should explore adapting or developing rural-specific theories. Study designs should employ more rigorous research methods to decrease bias and increase validity of findings. Follow-up assessments to determine behavioral maintenance and/or intervention sustainability are warranted. Finally, funding agencies and journals are encouraged to adopt rural-urban commuting area codes as the standard for defining rural.
Time spent sitting has been associated with an increased risk of diabetes, cancer, obesity, and mental health impairments. However, 75% of Americans spend most of their days sitting, with work-sitting accounting for 63% of total daily sitting time. Little research examining theory-based antecedents of standing or sitting has been conducted. This lack of solid groundwork makes it difficult to design effective intervention strategies to decrease sitting behaviors. Using the Theory of Planned Behavior (TPB) as our theoretical lens to better understand factors related with beneficial standing behaviors already being practiced, we examined relationships between TPB constructs and time spent standing at work among “positive deviants” (those successful in behavior change). Experience sampling methodology (ESM), 4 times a day (midmorning, before lunch, afternoon, and before leaving work) for 5 consecutive workdays (Monday to Friday), was used to assess employees' standing time. TPB scales assessing attitude (α = 0.81–0.84), norms (α = 0.83), perceived behavioral control (α = 0.77), and intention (α = 0.78) were developed using recommended methods and collected once on the Friday before the ESM surveys started. ESM data are hierarchically nested, therefore we tested our hypotheses using multilevel structural equation modeling with Mplus. Hourly full-time university employees (n = 50; 70.6% female, 84.3% white, mean age = 44 (SD = 11), 88.2% in full-time staff positions) with sedentary occupation types (time at desk while working ≥6 hours/day) participated. A total of 871 daily surveys were completed. Only perceived behavioral control (β = 0.45, p < 0.05) was related with work-standing at the event-level (model fit: just fit); mediation through intention was not supported. This is the first study to examine theoretical antecedents of real-time work-standing in a naturalistic field setting among positive deviants. These relationships should be further examined, and behavioral intervention strategies should be guided by information obtained through this positive deviance approach to enhance perceived behavioral control, in addition to implementing environmental changes like installing standing desks.
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