Publications by authors named "Kim D Reynolds"

43 Publications

Exploring Potential Mediation Pathways on the Relationship Between Acculturation and Body Mass Index (BMI) Among Latino Adolescents.

Hisp Health Care Int 2021 Jul 22:15404153211029893. Epub 2021 Jul 22.

School of Community and Global Health, Claremont Graduate University, CA, USA.

Background: Positive associations have been observed between acculturation and body mass index (BMI), but the mediators of this relationship are not well established. Acculturation researchers have called for investigating the influence of socio-contextual variables as mediators. The objective of this study was to test the mediating effects of salty snacks, sweet snacks, physical activity, and sedentary behavior on the relationship between acculturation and BMI among Latino adolescents.

Methods: Adolescents who self-identified as Latino ( = 431) at public high schools in Southern California were recruited and completed a self-report survey. A bootstrapped multiple mediation model was used to test mediation pathways.

Results: Acculturation was positively associated with physical activity ( = 0.09, < .05). The indirect effects of salty snacks, sweet snacks, physical activity, and sedentary behavior were not associated with BMI, suggesting no mediation.

Conclusions: Future research should examine additional mediating variables on the relationship between acculturation and BMI.
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http://dx.doi.org/10.1177/15404153211029893DOI Listing
July 2021

Loneliness and cravings for sugar-sweetened beverages among adolescents.

Pediatr Obes 2021 Jul 6:e12834. Epub 2021 Jul 6.

School of Community and Global Health, Claremont Graduate University, Claremont, California, USA.

Purpose: The consumption of sugar-sweetened beverages (SSBs) is associated with weight gain in both children and adults. In addition to environmental factors, such as food availability, psychological variables, including mood states, also impact intake. In the current study, we focus on momentary associations between feelings of loneliness and craving for SSBs among adolescents and explore the moderating role of family functioning. Loneliness has been associated with a wide range of health outcomes, but to date, few studies have examined its association with cravings for SSBs.

Methods: Using an ecological-momentary assessment design, data were collected on 158 (males = 68, mean age = 15.13 ± 2.27 years) participants. Multilevel mixed-effects models were used to examine the relations between the main and interactive effects of loneliness and family functioning on cravings for SSBs, independent of other negative emotions.

Results: Results suggest that loneliness in adolescents was associated with a small increase in craving for SSBs. Importantly, the relationship held after controlling for negative emotions, suggesting the unique role of loneliness. However, positive family functioning did not mitigate the relations between loneliness and craving for SSBs.

Conclusions: Loneliness uniquely contributes to cravings for SSBs. At the same time, family functioning did not buffer the influence of loneliness on cravings for SSBs among adolescents.
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http://dx.doi.org/10.1111/ijpo.12834DOI Listing
July 2021

An Examination of Family Variables as Mediators of the Association of Acculturation With Sugar-Sweetened Beverage Consumption Among Latinx Adolescents.

Fam Community Health 2020 Oct/Dec;43(4):287-295

School of Community and Global Health, Claremont Graduate University, Claremont, California.

The objective of this study was to examine the mediating effects of family support for dietary habits and family meal frequency on the relationship between acculturation and sugar-sweetened beverage (SSB) consumption among Latinx adolescents (N = 131). Acculturation was positively associated with SSB consumption (B = 0.07, P < .01). Results suggest that family support for dietary habits and family meal frequency did not mediate the relationship between acculturation and SSB consumption. However, acculturation was negatively associated with family support for dietary habits (B = -0.10, P < .01) and family meal frequency (B = -0.11, P < .05). Future research should examine other family influences as mediators of the relationship between acculturation and SSB consumption.
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http://dx.doi.org/10.1097/FCH.0000000000000278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483803PMC
December 2020

The Association of Trail Features With Self-Report Trail Use by Neighborhood Residents.

J Phys Act Health 2020 May 27;17(7):715-722. Epub 2020 May 27.

Background: Urban trails are a useful resource to promote physical activity. This study identified features of urban trails that correlated with trail use.

Methods: Multiuse urban trails were selected in Chicago, Dallas, and Los Angeles. An audit of each trail was completed using the Systematic Pedestrian and Cyclist Environmental Scan for Trails instrument, identifying built environmental features. A self-report of trail use was obtained from trailside residents (N = 331) living within 1 mile of each trail. Univariate and multivariate Poisson regressions controlled for trail time from home and motivation for physical activity.

Results: Positive associations with the past month's hours on the trail were observed for the presence of distance signs, vegetation height, vegetation maintenance, and trail crowding, and a negative association was observed for the presence of crossings on the trail. Positive associations with dichotomous trail use were observed for the presence of distance signs, vegetation height, and vegetation maintenance, and a negative association was observed for the presence of crossings on the trail.

Conclusions: These correlates should be confirmed in other studies and, if supported, should be considered in the promotion and design of urban trails.
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http://dx.doi.org/10.1123/jpah.2019-0347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274481PMC
May 2020

Parent reports of sun safety communication and behaviour for students in a randomised trial on a school policy implementation intervention.

Aust N Z J Public Health 2020 Jun 27;44(3):208-214. Epub 2020 May 27.

Kaiser Permanente Center for Health Research, Oregon, US.

Objective: Schools are an important setting for skin cancer prevention. An intervention for implementation of school sun safety policy, Sun Safety Schools (SSS), was evaluated.

Methods: Primary schools (n=118) in California school districts that had already adopted a sun safety policy were enrolled in a study with a randomised controlled design. Half of the schools were randomised to SSS intervention (N=58). Parents completed an online post-test.

Results: More parents in intervention schools received information about sun safety (mean=26.3%, sd=3.1%, p=0.017) and children more frequently wore sun-protective clothing when not at school (mean=2.93, sd=0.03, p=0.033) than in control schools (mean=18.0%, sd=2.5%; mean=2.83, sd=0.03, respectively). In schools where principals reported implementing sun safety practices, parents reported that children spent less time outdoors at midday (mean=14.78 hours, sd=0.25, p=0.033) and fewer were sunburned (mean=12.7%, sd=1.1%, p=0.009) than in non-implementing schools (M=16.3 hours, sd=0.67; mean=21.2%, sd=3.8%, respectively). Parents who received sun safety information (mean=3.08, sd=0.04, p=0.008) reported more child sun protection than parents not receiving information (mean=2.96, sd=0.02).

Conclusions: A school district sun protection policy and support for implementation increased dissemination of sun safety information to parents and student sun safety. Implications for public health: Technical assistance for sun safety policies may increase sun protection of children.
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http://dx.doi.org/10.1111/1753-6405.12987DOI Listing
June 2020

Randomized controlled trial evaluating an intervention supporting implementation of sun safety policies in California public elementary schools.

Prev Med 2020 08 7;137:106125. Epub 2020 May 7.

Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR 97227, USA.

Solar ultraviolet radiation (UV) exposure is the primary risk factor for skin cancer and children receive about one-quarter of lifetime UV exposure before age 18. Thus, skin cancer prevention is essential for children. The objective of this study was to test an intervention to facilitate implementation of district sun safety policies. Elementary schools (N = 118) from 40 California public school districts with a school board-approved policy for sun safety were recruited along with one principal and teacher from each school. Elementary schools were randomly assigned to receive the 20-month Sun Safe Schools intervention (N = 58) or to a minimal informational control condition (N = 60). Principals were 47.8 and teachers 44.3 years of age and were predominately female (principals 72.7%; teachers 86.7%) and White (principals 72.0%; teachers 68.2%). The 20-month Sun Safe Schools intervention was delivered to principals and included a coaching session, telephone and email contacts, provision of resources for practice implementation, and a small grant program. The principal (N = 118) and a teacher (N = 113) at each school reported on school sun protection practices 20-months post-baseline. The schools were diverse in student characteristics (M = 64.1% free/reduced price meals; M = 54.5% Hispanic). Intervention principals reported implementing more sun safety practices overall (control M = 2.7, intervention M = 4.2, p < .005) and more practices not present in the district's policy (control M = 0.4, intervention M = 0.9, p = .005). Principals and teachers combined replicated these findings and also reported implementing more practices present in the district policy (control M = 0.9, intervention M = 1.3, p = .005). In sum, the intervention increased sun safety practices in public elementary schools. Trial Registration. This study is registered in ClinicalTrials.gov, www.clinicaltrials.gov, with the identification number of NCT03243929.
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http://dx.doi.org/10.1016/j.ypmed.2020.106125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495886PMC
August 2020

School-Level Factors Associated with Sun Protection Practices in California Elementary Schools.

J Sch Health 2020 05 6;90(5):386-394. Epub 2020 Mar 6.

Klein Buendel, Inc. 1667 Cole Boulevard, Suite 225, Golden, CO, 80401.

Background: This study examined implementation of district sun safety policy in schools and tested correlates of implementation in California public school districts.

Methods: Principals (N = 118) and teachers (N = 113) in California public elementary schools (N = 118) were recruited and completed a survey on sun protection policies and practices. The sample contained schools whose districts subscribed to the California School Boards Association and adopted Board Policy 5141.7 for sun safety. Principals and teachers reported on implementation of 10 school practices related to BP 5141.7 indicating which practices were implemented in the school.

Results: Years in public education (Exponentiated Score (ES) = 0.51, p < .001), years worked in the current district (ES = 0.49, p < .001), perception that parents should take action to protect children from the sun (ES = 0.43, p < .01), and personal skin phenotype (Low Risk ES = 0.55; High Risk ES = 0.09, p < .05) were associated with number of practices implemented in the school using multiple Poisson regression.

Conclusions: Policy implementation is more likely among schools with experienced faculty, when parents are seen as important partners in student skin cancer prevention, and when school principals and teachers have a lower personal risk phenotype.
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http://dx.doi.org/10.1111/josh.12884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127930PMC
May 2020

Economic Evaluation of a Sun Protection Promotion Program in California Elementary Schools.

Am J Health Promot 2020 11 13;34(8):848-856. Epub 2020 Feb 13.

Klein Buendel, Inc, Golden, CO, USA.

Background: An economic evaluation of Sun Safe Schools intervention designed to aid California elementary schools with implementing sun safety practices consistent with local board-approved policy.

Design: Program cost analysis: intervention delivery and practice implementation.

Setting: California elementary schools (58 interventions and 60 controls). Principals at 52 intervention and 53 control schools provided complete implementation data.

Participants: Principals completing pre-/postintervention surveys assessing practice implementation.

Intervention: Phone-based 45-minute session with a project coach on practice implementation, follow-up e-mails/phone contacts, $500 mini-grant. Schools chose from a list of 10 practices for implementation: ultraviolet monitoring, clothing, hats, and/or sunscreen recommendations, outdoor shade, class education, staff training and/or modeling, parent outreach, and resource allocation. The duration of intervention was 20 months. Rolling recruitment/intervention: February 2014 to December 2017.

Measures: Intervention delivery and practice implementation costs. Correlations of school demographics and administrator beliefs with costs.

Analysis: Intervention delivery activities micro-costed. Implemented practices assessed using costing template.

Results: Intervention schools: 234 implemented practices, control schools: 157. Twenty-month delivery costs: $29 310; $16 653 (per school: $320) for project staff, mostly mini-grants and coaching time. Administrator costs: $12 657 (per school: $243). Per-student delivery costs: $1.01. Costs of implemented practices: $641 843 for intervention schools (per-school mean: $12 343, median: $6 969); $496 365 for controls (per-school mean: $9365, median: $3123). Delivery costs correlated with implemented practices (0.37, < .01) and total practice costs (0.37, < .05). Implemented practices correlated with principal beliefs about the importance of skin cancer prevention to student health (0.46, < .001) and parents (0.45, < .001).

Conclusion: Coaching of elementary school personnel can stimulate sun safety practice implementation at a reasonable cost. Findings can assist schools in implementing appropriate sun safety practices.
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http://dx.doi.org/10.1177/0890117120905217DOI Listing
November 2020

Acculturation and sugar-sweetened beverage consumption among Hispanic adolescents: The moderating effect of impulsivity.

Appetite 2019 03 19;134:142-147. Epub 2018 Dec 19.

School of Community and Global Health, Claremont Graduate University, 675 W. Foothill Blvd, Suite 310, Claremont, CA, 91711, USA. Electronic address:

Consumption of sugar-sweetened beverages is a risk factor for obesity. Acculturation to the United States (US) might increase sugar-sweetened beverage consumption among Hispanic adolescents, but few moderators of this relationship have been examined. This study examined the moderating influence of impulsivity on the association between acculturation and sugar-sweetened beverages. Hispanic adolescents (n = 154), 14-17 years, were identified and screened for eligibility through low-SES high schools and parents provided consent. Adolescents completed measures of acculturation using Unger's 8-item acculturation scale, impulsivity, and diet. Multiple linear regression was used to examine the main effect of acculturation and the interaction of acculturation with impulsivity on the diet outcomes: sugar-sweetened beverage consumption and percent of calories from sugar. Acculturation was positively associated with sugar-sweetened beverages (β = 0.43; p < .05). The interaction of acculturation x impulsivity was significant (β = 0.42, p < .05). Among youth who were more acculturated, those who were more impulsive consumed more sugar-sweetened beverages. Youth who were more acculturated, but less impulsive consumed less sugar-sweetened beverages. Neurocognitive variables such as impulsivity may be important moderators of the influence of acculturation on dietary behavior. Targeted messaging strategies based on levels of acculturation and impulsivity might enhance the effectiveness of interventions designed to reduce the intake of sugar-sweetened beverages among Hispanic adolescents.
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http://dx.doi.org/10.1016/j.appet.2018.12.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895500PMC
March 2019

Family functioning, moods, and binge eating among urban adolescents.

J Behav Med 2019 06 15;42(3):511-521. Epub 2018 Dec 15.

School of Community and Global Health, Claremont Graduate University, 675 W. Foothill Blvd., Ste. 310, Claremont, CA, 91711, USA.

This study builds upon prior research on associations between moods, family functioning, and binge eating, using ecological momentary assessment to examine moderating effects of family functioning on associations between moods and binge eating. This study was conducted among a nonclinical sample of urban adolescents. Family functioning was assessed using five constructs adopted from the FACES-IV measure: 'family cohesion,' 'family flexibility' 'family communication,' 'family satisfaction,' and 'family balance.' Mood data was gathered using 13 items from a daily affect scale. Binge eating was assessed using two subscales from the Eating Disorder Diagnostic Scale-binge eating associated with 'embarrassment' (BE1), and binge eating associated with a sense of 'loss of control' (BE2). A multilevel modeling approach was employed to examine how associations between momentary moods and binge eating behaviors were moderated by family functioning. Results indicated that measures of negative affect, stress/frustration, and tiredness/boredom were significantly and positively associated with two measures of binge eating (BE1 and BE2; p values ≤ 0.05), and that multiple factors of family functioning buffered the positive predictive effects of moods on binge eating. Findings indicate the importance of inclusion of family functioning in the development of eating behavior interventions for adolescents.
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http://dx.doi.org/10.1007/s10865-018-9994-8DOI Listing
June 2019

Accuracy of Principal and Teacher Knowledge of School District Policies on Sun Protection in California Elementary Schools.

Prev Chronic Dis 2018 01 18;15:E07. Epub 2018 Jan 18.

Kaiser Permanente Center for Health Research, Portland, Oregon.

Introduction: Policy is a key aspect of school-based efforts to prevent skin cancer. We explored the extent and accuracy of knowledge among principals and teachers in California public school districts about the elements specified in their district's written sun safety policy.

Methods: The sample consisted of California public school districts that subscribed to the California School Boards Association, had an elementary school, adopted Board Policy 5141.7 for sun safety, and posted it online. The content of each policy was coded. Principals (n = 118) and teachers (n = 113) in elementary schools were recruited from September 2013 through December 2015 and completed a survey on sun protection policies and practices from January 2014 through April 2016.

Results: Only 38 of 117 principals (32.5%) were aware that their school district had a sun protection policy. A smaller percentage of teachers (13 of 109; 11.9%) than principals were aware of the policy (F = 12.76, P < .001). We found greater awareness of the policy among principals and teachers who had more years of experience working in public education (odds ratio [OR] = 1.05, F = 4.71, P = .03) and worked in schools with more non-Hispanic white students (OR = 7.65, F = 8.61, P = .004) and fewer Hispanic students (OR = 0.28, F = 4.27, P = .04).

Conclusion: Policy adoption is an important step in implementing sun safety practices in schools, but districts may need more effective means of informing school principals and teachers of sun safety policies. Implementation will lag without clear understanding of the policy's content by school personnel.
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http://dx.doi.org/10.5888/pcd15.170342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774306PMC
January 2018

Sun Protection Policies in Public School Districts With Elementary Schools in California.

JAMA Dermatol 2018 01;154(1):103-105

School of Community & Global Health, Claremont Graduate University, Claremont, California.

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http://dx.doi.org/10.1001/jamadermatol.2017.3725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833571PMC
January 2018

A Longitudinal Analysis of the Effects of Socioeconomic Factors, Foreign Media, and Attitude toward Appearance on General and Central Adiposity in Chinese Adolescents.

Prev Med Rep 2015;2:608-214

Claremont Graduate University, School of Community and Global Health, 675 West Foothill Boulevard, Suite 310, Claremont, CA 91711, .

Objective: This paper explores the longitudinal effects of socioeconomic factors (i.e., parent education and family income level), foreign media, and attitude toward appearance on general and central adiposity among Chinese adolescents.

Method: A longitudinal analysis was performed using data from the China Seven Cities Study, a health promotion and smoking prevention study conducted in seven cities across Mainland China between 2002 and 2005. Participants included 5,020 middle and high school students and their parents. Explanatory variables included foreign media exposure, attitude toward appearance, parent education, and family income. Three-level, random-effect models were used to predict general adiposity (i.e., body mass index) and central adiposity (i.e., waist circumference). The Generalized Estimating Equation approach was utilized to determine the effect of explanatory variables on overweight status.

Results: Among girls, foreign media exposure was significantly negatively associated with general adiposity over time (β=-0.06, p=0.01 for middle school girls; β=-0.06, p=0.03 for high school girls). Attitude toward appearance was associated with lesser odds of being overweight, particularly among high school girls (OR=0.86, p<0.01). Among boys, parental education was significantly positively associated with general adiposity (β=0.62, p<0.01 for middle school boys; β=0.37, p=0.02 for high school boys) and associated with greater odds of being overweight (OR=1.55, p<0.01 for middle school boys; OR=1.26, p=0.04 for high school boys). Across all gender and grade levels, family income was significantly negatively associated with central adiposity over time.

Conclusion: Interventions addressing Chinese adolescent overweight/obesity should consider these factors as potential focus areas.
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http://dx.doi.org/10.1016/j.pmedr.2015.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535427PMC
January 2015

Overweight Perception: Associations with Weight Control Goals, Attempts, and Practices among Chinese Female College Students.

J Acad Nutr Diet 2016 Mar 7;116(3):458-466. Epub 2015 Aug 7.

Background: Concurrent with the dramatic cultural and economic shifts occurring as mainland China becomes increasingly "Westernized," the weight perceptions, ideal body weight, and weight management goals and practices of Chinese females have also undergone significant changes.

Objective: To investigate relationships between overweight status, weight perception patterns, and weight management goals and practices in Chinese female college students.

Design/participants/setting: A cross-sectional analysis was conducted with data from 902 female subjects aged 18 to 25 years participating in the China Seven Cities Study, a health promotion and smoking prevention study conducted in mainland China in 2003.

Main Outcome Measures/statistical Analyses: Logistic regression models were used to explore associations between overweight status, weight perception, specific weight management goals and practices, and current levels of vigorous-intensity physical activity and food consumption.

Results: Based on World Health Organization standards for Asian adults, 16.7% of college females were overweight or obese, although 50.8% considered themselves to be "too heavy." Among participants perceiving themselves as overweight (n=458), 69.2% (n=371) were inaccurate and did not meet criteria for overweight or obese. The percentage of participants attempting weight loss was 48.2%, and 33.1% wanted to maintain their current weight. Attempts to lose or maintain weight were related to actual and perceived weight status, but not to increased vigorous-intensity physical activity or fruit and vegetable intake, nor to decreased consumption of sweets, soda, Western fast foods, and fried foods. Only 21.5% of participants desiring weight loss or maintenance reported using a combination of vigorous-intensity physical activity and a reduced-fat and -calorie diet, whereas 20.2% tried extreme methods such as fasting, using diet pills, vomiting, or smoking.

Conclusions: Our findings underscore the need to promote healthy weight management practices among Chinese female college students, with an emphasis on diet and physical activity strategies that encourage balance rather than extremes.
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http://dx.doi.org/10.1016/j.jand.2015.06.383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744809PMC
March 2016

From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases.

Health Psychol 2015 Oct 2;34(10):971-82. Epub 2015 Feb 2.

Center for Integrative Medicine, Weill Cornell Medical College.

Objective: Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases.

Method: The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization.

Results: This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases.

Conclusions: The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522392PMC
October 2015

Ecological momentary assessment of urban adolescents' technology use and cravings for unhealthy snacks and drinks: differences by ethnicity and sex.

J Acad Nutr Diet 2015 May 4;115(5):759-766. Epub 2014 Dec 4.

Background: Adolescents' technology use is generally associated with food cravings, but it is not clear whether specific types of technology elicit particular types of cravings or whether personal characteristics play a role in these associations.

Objective: We examined whether momentary associations between four technology types (ie, television, video games, computer messaging, and phone messaging) and cravings for unhealthy snack foods and sweetened drinks were moderated by youths' sex, ethnicity, body mass index, and age.

Methods: Urban adolescents (N=158) aged 14 to 17 years provided momentary information about their technology use and food cravings during the course of 1 week and completed survey reports of their personal characteristics. We used multilevel modeling to determine momentary associations and interactions.

Results: Non-Hispanic adolescents showed stronger associations between television exposure and cravings for sweet snacks, salty snacks, and sweetened drinks. Being Hispanic was associated with stronger associations between phone messaging and cravings for sweet snacks, salty snacks, and sweetened drinks. Males showed stronger associations between video game use and salty snack cravings.

Conclusions: As the public health field continues to monitor the effects of technology use on adolescents' eating and overall health, it will be important to determine the extent to which these groups are differentially affected by different forms of technology.
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http://dx.doi.org/10.1016/j.jand.2014.10.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410055PMC
May 2015

Recruitment results among families contacted for an obesity prevention intervention: the Obesity Prevention Tailored for Health Study.

Trials 2014 Nov 27;15:463. Epub 2014 Nov 27.

Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S, Los Robles, 2nd Floor, Pasadena, CA 91101, USA.

Background: Overweight and obesity are serious threats to health and increase healthcare utilization and costs. The Obesity Prevention Tailored for Health (OPT) study was designed to test the effectiveness of a family-based intervention targeting diet and physical activity. We describe the results of efforts to recruit parents and children enrolled in a large managed-care organization into the OPT study.

Methods: Parents with 10- to 12-year-old children were randomly selected from the membership of Kaiser Permanente Southern California, a large integrated health plan, and contacted between June 2010 and November 2011. We describe recruitment outcomes and compare characteristics of parents and children who did and did not participate. Information was collected from calls with parents and through the administrative and electronic medical records of the health plan.

Results: Of the 4,730 parents contacted, 16.1% expressed interest in participation (acceptors), 28.8% declined participation (refusers), 4.7% were ineligible, and, even after multiple attempts, we were unable to reach 50.4%. Slightly less than half of the acceptors (n = 361) were ultimately randomized to receive either the OPT program plus usual care or usual care alone (7.6% of all parents initially contacted). There were not any significant differences between acceptors who were or were not randomized. Overall, we found that acceptors were more likely to be female parents, have overweight/obese children, and higher utilization of outpatient visits by parents and children compared with refusers and those we were unable to reach. We found no differences in recruitment outcomes by body mass index or comorbidity score of the parents, level of physical activity of the parents and children, education of the parents, or household income.

Conclusions: Recruiting parents and children into an obesity prevention program in a healthcare setting proved to be challenging and resource-intensive. Barriers and incentives for participation in obesity prevention programs need to be identified and addressed. Concern for the weight of their children may motivate parents to participate in family-based lifestyle interventions; however, the healthcare setting may be more relevant to weight-related treatment than to primary prevention.

Trial Registration:

Trial Registration Number: ISRCTN06248443, 30 January 2014.
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http://dx.doi.org/10.1186/1745-6215-15-463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256806PMC
November 2014

Inhibitory control effects in adolescent binge eating and consumption of sugar-sweetened beverages and snacks.

Appetite 2014 Oct 17;81:180-92. Epub 2014 Jun 17.

School of Community and Global Health, Claremont Graduate University, 675 West foothill Blvd. Suite 310, Claremont, CA 91711-3475, USA.

Inhibitory control and sensitivity to reward are relevant to the food choices individuals make frequently. An imbalance of these systems can lead to deficits in decision-making that are relevant to food ingestion. This study evaluated the relationship between dietary behaviors - binge eating and consumption of sweetened beverages and snacks - and behavioral control processes among 198 adolescents, ages 14 to 17. Neurocognitive control processes were assessed with the Iowa Gambling Task (IGT), a generic Go/No-Go task, and a food-specific Go/No-Go task. The food-specific version directly ties the task to food cues that trigger responses, addressing an integral link between cue-habit processes. Diet was assessed with self-administered food frequency and binge eating questionnaires. Latent variable models revealed marked gender differences. Inhibitory problems on the food-specific and generic Go/No-Go tasks were significantly correlated with binge eating only in females, whereas inhibitory problems measured with these tasks were the strongest correlates of sweet snack consumption in males. Higher BMI percentile and sedentary behavior also predicted binge eating in females and sweet snack consumption in males. Inhibitory problems on the generic Go/No-Go, poorer affective decision-making on the IGT, and sedentary behavior were associated with sweetened beverage consumption in males, but not females. The food-specific Go/No-Go was not predictive in models evaluating sweetened beverage consumption, providing some initial discriminant validity for the task, which consisted of sweet/fatty snacks as no-go signals and no sugar-sweetened beverage signals. This work extends research findings, revealing gender differences in inhibitory function relevant to behavioral control. Further, the findings contribute to research implicating the relevance of cues in habitual behaviors and their relationship to snack food consumption in an understudied population of diverse adolescents not receiving treatment for eating disorders.
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http://dx.doi.org/10.1016/j.appet.2014.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127340PMC
October 2014

Factors predicting the capacity of Los Angeles city-region recreation programs to promote energy expenditure.

Health Place 2014 Jul 19;28:67-72. Epub 2014 Apr 19.

University of California, Berkeley, School of Public Health, 50 University Hall #7360, Berkeley, CA 9472, USA. Electronic address:

An audit of recreation programs with moderate or higher levels of physical activity (PA) in Los Angeles area cities (N=82) was conducted using internet, telephone, and survey methods. Metabolic Equivalents (METs) were used to code programs׳ physical activity intensity. MET-hours per recreation program was associated with required age for enrollment, percent of residents >64 years of age, and fiscal capacity of cities. Capacity to promote energy expenditure may depend on targeted age groups, age of population, and municipal fiscal capacity. Cities with lower fiscal capacity might offer those higher MET-hour activities which require less specialized equipment and seek outside funding to offer higher MET programs.
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http://dx.doi.org/10.1016/j.healthplace.2014.03.008DOI Listing
July 2014

Sweetened drink and snacking cues in adolescents: a study using ecological momentary assessment.

Appetite 2013 Aug 11;67:61-73. Epub 2013 Apr 11.

School of Community and Global Health, Claremont Graduate University, 675 West Foothill Blvd. Suite 310, Claremont, CA 91711-3475, USA.

The objective of this study was to identify physical, social, and intrapersonal cues that were associated with the consumption of sweetened beverages and sweet and salty snacks among adolescents from lower SES neighborhoods. Students were recruited from high schools with a minimum level of 25% free or reduced cost lunches. Using ecological momentary assessment, participants (N=158) were trained to answer brief questionnaires on handheld PDA devices: (a) each time they ate or drank, (b) when prompted randomly, and (c) once each evening. Data were collected over 7days for each participant. Participants reported their location (e.g., school grounds, home), mood, social environment, activities (e.g., watching TV, texting), cravings, food cues (e.g., saw a snack), and food choices. Results showed that having unhealthy snacks or sweet drinks among adolescents was associated with being at school, being with friends, feeling lonely or bored, craving a drink or snack, and being exposed to food cues. Surprisingly, sweet drink consumption was associated with exercising. Watching TV was associated with consuming sweet snacks but not with salty snacks or sweet drinks. These findings identify important environmental and intrapersonal cues to poor snacking choices that may be applied to interventions designed to disrupt these food-related, cue-behavior linked habits.
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http://dx.doi.org/10.1016/j.appet.2013.03.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677830PMC
August 2013

School sun-protection policies: measure development and assessments in 2 regions of the United States.

J Sch Health 2012 Nov;82(11):499-507

School of Community and Global Health, Claremont Graduate University, CA 91711, USA.

Background: In 2002, the US Centers for Disease Control and Prevention recommended that schools adopt policies that reduce exposure of children to ultraviolet radiation to prevent skin cancer. We report here the development of a school sun-safety policy measure and baseline descriptive statistics from the assessment of written policies collected in 2005-2007 from public school districts that enrolled in a randomized trial evaluating a policy promotion program.

Methods: Written policies were collected from 103 of 112 school districts in Colorado and Southern California prior to randomization. We developed methods for selecting policy headings/sections topics likely to contain sun-safety policies for students and for assessing the presence, strength, and intent of policies. Trained coders assessed the content of each policy document.

Results: Overall, 31% of districts had a policy addressing sun safety, most commonly, protective clothing, hats, sunscreen, and education at baseline. More California districts (51.9%) had these policies than Colorado districts (7.8%, p < .001). Policy scores were highest in districts with fewer Caucasian students (b = -0.02, p = .022) in Colorado (b = -0.02, p = .007) but not California (b = 0.01, p = .299).

Conclusion: The protocol for assessing sun-safety policy in board-approved written policy documents had several advantages over surveys of school officials. Sun-protection policies were uncommon and limited in scope in 2005-2007. California has been more active at legislating school policy than Colorado. School district policies remain a largely untapped method for promoting the sun protection of children.
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http://dx.doi.org/10.1111/j.1746-1561.2012.00729.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475509PMC
November 2012

Comments on the use of alternative designs in dissemination research.

Am J Prev Med 2012 Jan;42(1):105-6

School of Community and Global Health, Claremont Graduate University, Claremont, California 91711, USA.

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http://dx.doi.org/10.1016/j.amepre.2011.10.001DOI Listing
January 2012

Motivating public school districts to adopt sun protection policies: a randomized controlled trial.

Am J Prev Med 2011 Sep;41(3):309-16

Research, Klein Buendel Inc., 1667 Cole Boulevard, Denver, CO 80401, USA.

Background: In 2002, CDC recommended that the nation's schools establish policies that reduce sun exposure to decrease students' risk of skin cancer.

Purpose: A program to convince public school districts to adopt such a policy was evaluated.

Design: RCT.

Setting/participants: Public school districts in Colorado (n=56) and Southern California (n=56).

Intervention: Policy information, tools, and technical assistance were provided through printed materials, a website, meetings with administrators, and presentations to school boards. An RCT enrolled public school districts from 2005 to 2010. Policy adoption was promoted over 2 years at districts randomized to the intervention.

Main Outcome Measures: School board-approved policies were obtained from 106 districts and coded at baseline and 2-year follow-up. Analyses were conducted in 2010.

Results: There was no difference in the percentage of districts adopting a policy (24% in intervention; 12% in control; p=0.142); however, intervention districts (adjusted M=3.10 of 21 total score) adopted stronger sun safety policies than control districts (adjusted M=1.79; p=0.035). Policy categories improved on sun safety education for students (intervention adjusted M=0.76; control adjusted M=0.43, p=0.048); provision of outdoor shade (intervention adjusted M=0.79; control adjusted M=0.28, p=0.029); and outreach to parents (intervention adjusted M=0.59; control adjusted M=0.20, p=0.027).

Conclusions: Multifaceted promotion can increase adoption of stronger policies for reducing sun exposure of students by public school districts. Future research should explore how policies are implemented by schools.
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http://dx.doi.org/10.1016/j.amepre.2011.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3167690PMC
September 2011

Preliminary evidence for mediation of the association between acculturation and sun-safe behaviors.

Arch Dermatol 2011 Jul;147(7):814-9

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA.

Objectives: To identify and test mediators of the relationship between acculturation and sun-safe behaviors among Latinos in the United States. We hypothesized that the effect of acculturation on use of sunscreen, shade, and sun-protective clothing would be mediated by perceived health status, educational level, access to health care, and contact with social networks regarding health matters.

Design: The 2005 Health Information National Trends Survey, implemented by the National Cancer Institute.

Setting: Nationwide survey.

Participants: A probability-based sample of the US civilian, noninstitutionalized adult population, comprising 496 Latino respondents.

Main Outcome Measures: Use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days, assessed by self-report on frequency scales.

Results: The positive association between acculturation and sunscreen use and the negative association between acculturation and use of sun-protective clothing were mediated by educational level (P < .05 for both). Perceived health status and contact with social networks regarding health matters were supported as mediators for sunscreen use only (P < .05). Health care access was not supported as a mediator for any of the outcomes.

Conclusions: Structural equation models revealed distinct direct and indirect paths between acculturation and each sun-safe practice. Our findings emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation. The models support educational level, contact with social networks regarding health matters, and perceived health status as mediators primarily for sunscreen use. Future research should test different mediators for use of shade or sun-protective clothing.
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http://dx.doi.org/10.1001/archdermatol.2011.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353392PMC
July 2011

Development, reliability, and validity of an urban trail use survey.

Am J Health Promot 2010 Sep-Oct;25(1):2-11

Institute of Health Promotion and Disease Prevention, University of Southern California, Alhambra, California 91803, USA.

Purpose: To evaluate the psychometric characteristics of the Research on Urban Trail Environments (ROUTES) Trail Use Questionnaire.

Design: Test-retest reliability was assessed by repeated measures (study 1); validity was assessed by comparing reported trail use to self-reported and objectively measured physical activity (PA) levels (study 2).

Setting: Study 1: a religious institution situated near a Los Angeles trail. Study 2: 1-mile buffer zones surrounding three urban trails (Chicago, Dallas, and Los Angeles).

Subjects: Thirty-four adults between 40 and 60 years of age (10 men and 24 women) completed the ROUTES questionnaire twice (study 1). Study 2 participants were 490 adults (48% female and 73% white), mean age 48 years.

Measures: Trail use for recreation and transportation purposes, time and distance spent on trails, and characteristics of the trail and other trail users. PA was measured using the International Physical Activity Questionnaire and accelerometry.

Analyses: Pearson correlation coefficients and kappa statistics were used for test-retest reliability for continuous and categorical variables, respectively. Generalized linear models were used to evaluate hypotheses on PA comparing trail users and nonusers.

Results: Test-retest statistics were acceptable (kappa = .57, r = .66). Validity was supported by correlations between indices of trail use with self-reported PA and accelerometry, and significant group differences between trail users and nonusers in PA levels.

Conclusions: The ROUTES Trail Use Questionnaire demonstrated good reliability and validity.
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http://dx.doi.org/10.4278/ajhp.071105119DOI Listing
January 2011

Reliability of an audit tool for systematic assessment of urban alleyways.

J Phys Act Health 2010 Mar;7(2):214-23

Department of Geography, University of Southern California, Los Angeles, CA, USA.

Background: Reliable audit tools are needed to examine the potential of built environment features for physical activity.

Methods: An audit tool for alley environments was developed with land use, substrate, and use, condition, and safety items. Two audit teams independently audited 29 Los Angeles alleys, and interteam reliability was calculated with Cohen's and prevalence-adjusted, bias-adjusted kappa (PABAK) statistics; intraclass correlation coefficients; and percent observed agreement.

Results: Forty-two of 47 dichotomous items analyzed for reliability had PABAK values > or = 0.61 ("substantial agreement"). Sixteen of 23 ordinal and continuous response items analyzed had ICCs > or = 0.61, and an additional 6 with lower ICC values had observed agreement > or = 79%. Items concerning the presence or absence of use-related alley features demonstrated the lowest reliability.

Conclusions: The instrument has acceptable reliability for most of its items and appears to be a promising tool for use by other researchers and professionals in the measurement of alley environments.
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http://dx.doi.org/10.1123/jpah.7.2.214DOI Listing
March 2010

The intersection of public policy and health behavior theory in the physical activity arena.

J Phys Act Health 2010 Mar;7 Suppl 1:S91-8

Dept. of Preventive Medicine, University of Southern California, Alhambra, CA, USA.

Background: Policy strategies aimed at modifying aspects of the social, physical, economic, and educational environments have been proposed as potential solutions to the growing problem of physical inactivity. To develop effective physical activity policies in these and other areas, greater understanding of how and why policies successfully impact behavior change is needed.

Methods: The current paper proposes a conceptual framework explaining how policy strategies map onto health behavior theoretical variables and processes thought to lead to physical activity change. This framework is used to make hypotheses about the potential effectiveness of different policy strategies.

Results: Health behavior theories suggest that policies providing information may be particularly useful for individuals who are not yet considering or have only recently begun to consider becoming more physically active. Policies that provide opportunities may be less effective for individuals who do not find physical activity to be inherently fun and interesting. Policies that offer incentives or require the behavior may not be particularly useful at promoting long-term changes in physical activity.

Conclusion: Exploring possible connections between policy strategies and theoretical constructs can help to clarify how each approach might work and for whom it may be the most appropriate to implement.
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http://dx.doi.org/10.1123/jpah.7.s1.s91DOI Listing
March 2010

Moderated mediation regarding the sun-safe behaviors of U.S. Latinos: advancing the theory and evidence for acculturation-focused research and interventions.

J Immigr Minor Health 2010 Oct;12(5):691-8

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Recent studies revealed a negative association between acculturation and sun-safe behaviors, possibly mediated by education level, health status, and social networks. We sought to elucidate this relationship by exploring the moderating effects of gender and health insurance on each mediated path. We used data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Acculturation, assessed by a four-item index, was the primary predictor; use of sunscreen and protective clothing were the primary outcomes, assessed by frequency scales. Moderated mediation was tested with an established causal moderation method. The mediated association between acculturation, education level and sunscreen use might be stronger among women than men (P < 0.08). We found no evidence of moderated mediation for use of protective clothing. The findings suggest ways of refining the theoretical and empirical rationale for sun safety research and interventions with Latinos. Studies should replicate these models with longitudinal data.
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http://dx.doi.org/10.1007/s10903-009-9302-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810164PMC
October 2010

Reasons for urban trail use predict levels of trail-related physical activity.

J Phys Act Health 2009 Jul;6(4):426-34

Dept of Preventive Medicine, University of Southern California, Alhambra, CA, USA.

Background: Efforts to increase community levels of physical activity through the development of multiuse urban trails could be strengthened by information about factors predicting trail use. This study examined whether reasons for trail use predict levels of physical activity on urban trails.

Methods: Adults (N = 335) living within a 1-mile buffer zone of urban trails in Chicago, Dallas, and Los Angeles completed a self-report measure assessing demographics, reason for trail use, and physical activity on the trail. Accelerometers measured total daily moderate-to-vigorous physical activity (MVPA). Environmental features of the urban trail were assessed with the Systematic Pedestrian and Cyclist Environmental Scan for trails measure. Multivariate regression analyses were conducted that accounted for clustering of individuals within trail segments.

Results: After controlling for demographic and environmental factors and total daily MVPA, reasons for trail use significantly predicted recreational but not transportation activity. Recreational trail activity was greater for participants who reported exercise and health reasons for trail use as compared with other reasons (ie, social interaction, enjoying nature, walking pets) for recreational trail use.

Conclusions: To increase the use of urban trails, it may be useful to promote the health and exercise benefits of recreational trail use.
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http://dx.doi.org/10.1123/jpah.6.4.426DOI Listing
July 2009

Acculturation and sun-safe behaviors among US Latinos: findings from the 2005 Health Information National Trends Survey.

Am J Public Health 2009 Apr 15;99(4):734-41. Epub 2009 Jan 15.

Department of Preventive Medicine, Keck School of Medicine, University of Southern California,Los Angeles, CA, USA.

Objectives: We examined the relationship between acculturation and sun safety among US Latinos.

Methods: We used linear regression models to analyze data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Using sunscreen, seeking shade, and wearing protective clothing were the primary outcomes and were assessed by frequency scales. Acculturation was assessed with a composite index.

Results: In bivariate models, acculturation was negatively associated with use of shade and protective clothing and positively associated with sunscreen use (all, P < .004). In adjusted models, acculturation was negatively associated with seeking shade and wearing protective clothing across gender and region of residence (all, P < .05).

Conclusions: Our results demonstrated both adverse and beneficial effects of acculturation on Latinos' risk behaviors relating to skin cancer. Education about sun safety is needed for all Latinos and should be tailored to different levels of acculturation. Initiatives for Latinos who are not yet acculturated could focus on reinforcing existing sun-safe behaviors and presenting new ones, such as use of sunscreen; initiatives for highly acculturated Latinos might require more resources because the objective is behavior modification.
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http://dx.doi.org/10.2105/AJPH.2007.122796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661486PMC
April 2009
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