Publications by authors named "Ruth Saunders"

147 Publications

Operationalizing and Testing the Concept of a Physical Activity Desert.

J Phys Act Health 2021 03 30;18(5):533-540. Epub 2021 Mar 30.

Background: The prevalence of childhood obesity is higher in economically and socially deprived areas. Higher levels of physical activity reduce the risk of excessive weight gain in youth, and research has focused on environmental factors associated with children's physical activity, though the term "physical activity desert" has not come into wide use.

Methods: This exploratory study operationalized the term "physical activity desert" and tested the hypothesis that children living in physical activity deserts would be less physically active than children who do not. A cross-sectional study design was applied with 992 fifth-grade students who had provided objectively measured physical activity data. Five of 12 possible elements of the built environment were selected as descriptors of physical activity deserts, including no commercial facilities, no parks, low play spaces, no cohesion, and the presence of incivilities.

Results: Univariate and multivariate analyses showed that only the absence of parks was associated with less physical activity in children.

Conclusion: Children living in a "no park" zone were less active than their counterparts who lived near a park. This study contributes preliminary conceptual and operational definitions of "physical activity desert." Future studies of physical activity deserts should be undertaken in larger and more diverse samples.
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http://dx.doi.org/10.1123/jpah.2020-0382DOI Listing
March 2021

Pathways of influences leading to adoption of the Faith, Activity and Nutrition (FAN) program in a statewide initiative.

Eval Program Plann 2021 Aug 16;87:101941. Epub 2021 Mar 16.

South Carolina Conference of the United Methodist Church, Columbia, SC, 29203, USA.

RE-AIM (Reach, effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) are complementary frameworks guiding research on dissemination and implementation of evidence-based interventions and factors influencing this process. Faith, Activity, and Nutrition (FAN) is an evidence-based program that increased physical activity and fruit and vegetable intake in faith-based settings. The aims of this adoption study were to quantify state-wide church level adoption rates and congregant reach of FAN in accordance with RE-AIM guidelines, and to explore the association of CFIR-derived constructs of the church inner setting and pastor characteristics with FAN adoption. Church recruitment was documented, and data were collected via telephone-administered surveys from 93 pastors in adopting churches and 60 pastors in non-adopting churches. Qualitative Comparative Analysis (QCA) identified combinations of CFIR-derived church and pastor characteristics sufficient for FAN adoption. As defined by RE-AIM, church-level FAN adoption was 11.7 % and congregant-level reach was 20.0 %. Fourteen pathways to adoption were identified; seven of these featured the presence of a culture of concern for congregant health along with openness to new ideas. Results suggest early assessment of these two CFIR-derived inner setting constructs may help identify faith-based organizations predisposed to undertake a comprehensive, environmental intervention to promote congregant health.
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http://dx.doi.org/10.1016/j.evalprogplan.2021.101941DOI Listing
August 2021

Program Implementation and Church Members' Health Behaviors in a Countywide Study of the Faith, Activity, and Nutrition Program.

Prev Chronic Dis 2021 01 14;18:E05. Epub 2021 Jan 14.

Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

Implementation research of health programs in faith-based organizations is lacking. The Faith, Activity, and Nutrition (FAN) program helps churches improve physical activity and fruit and vegetable behaviors of members. This study examined associations between implementation of FAN intervention components and church members' physical activity, fruit and vegetable behaviors, and self-efficacy for improving these behaviors. FAN was implemented in 35 churches in a southeastern US county. After attending in-person training, led by community health advisors, church committees received 12 months of telephone-delivered technical assistance to implement FAN according to 4 components: increasing opportunities, increasing guidelines and policies, increasing pastor support, and increasing messages for physical activity and healthy eating in their church. In this correlational study, FAN coordinators (n = 35) for each church reported baseline practices in 2015 and 12-month follow-up implementation of the 4 components for physical activity and healthy eating in 2016. Church members (n = 893) reported perceived implementation, physical activity and fruit and vegetable behaviors, and self-efficacy at 12-month follow-up in 2016. Independent variables were coordinator-reported baseline practices, baseline-adjusted 12-month implementation, and member-perceived 12-month implementation. Multilevel modeling examined associations between independent variables and member-reported 12-month physical activity and fruit and vegetable behaviors and self-efficacy. Coordinator-reported 12-month implementation of fruit and vegetable opportunities was associated with member fruit and vegetable consumption. Member perceptions at 12 months of church physical activity opportunities, pastor support, and messages were associated with higher self-efficacy for physical activity; pastor support and messages were positively associated with physical activity. Member perceptions at 12 months of fruit and vegetable opportunities, pastor support, and messages were associated with higher fruit and vegetable consumption and self-efficacy. Member-perceived implementation was more strongly associated with member behaviors than coordinator-reported implementation. Providing opportunities for healthy eating during already scheduled events may be an effective strategy for improving fruit and vegetable behavior.
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http://dx.doi.org/10.5888/pcd18.200224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845546PMC
January 2021

Healthy Eating and Physical Activity Interventions in Faith-Based Settings: A Systematic Review Using the Reach, Effectiveness/Efficacy, Adoption, Implementation, Maintenance Framework.

Am J Prev Med 2021 01;60(1):127-135

Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

Context: Faith-based health interventions may improve obesity-related health behaviors, including healthy eating and physical activity. However, the generalizability of results and comprehensiveness of reporting for critical design elements sufficient for large-scale implementation and broad public health impact are unclear. This review assesses the degree to which faith-based healthy eating and physical activity programs report intervention elements using the reach, effectiveness/efficacy, adoption, implementation, maintenance framework.

Evidence Acquisition: A systematic literature search was initiated in June 2017, and updated searches concluded in December 2019. Articles were included if they (1) were published in an English language peer-reviewed journal, (2) were conducted in the U.S., (3) were interventions, (4) included individual-level healthy eating or physical activity behavioral outcomes, (5) were conducted within an organizational setting, and (6) were faith-based. Intervention elements were extracted, and comprehensiveness of reporting for intervention elements was assessed according to reach, effectiveness/efficacy, adoption, implementation, maintenance domains.

Evidence Synthesis: A total of 38 interventions (46 articles) met the inclusion criteria. Most were conducted at the individual/interpersonal level (66%); few included additional elements of policy or environmental change (34%). Most interventions showed favorable changes in at least 1 health behavior outcome. No intervention addressed all reach, effectiveness/efficacy, adoption, implementation, maintenance indicators. The mean level of reporting was low for all reach, effectiveness/efficacy, adoption, implementation, maintenance dimensions (reach: 2.3 of 5 [SD=1.0] indicators, efficacy/effectiveness: 2.3 of 4 [SD=0.8] indicators, adoption: 3.7 of 6 [SD=1.4] indicators, implementation: 1.3 of 3 [SD=0.6] indicators, maintenance: 0.3 of 3 [SD=0.5] indicators).

Conclusions: Studies reporting outcomes of faith-based interventions to improve healthy eating/physical activity behaviors lack the information necessary to understand the potential for broad dissemination and implementation in community settings. Future studies should report on the considerations for the translation and dissemination of evidence-based programs to expand public health impact.
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http://dx.doi.org/10.1016/j.amepre.2020.05.014DOI Listing
January 2021

Fibrocyte localisation to the ASM bundle in asthma: bidirectional effects on cell phenotype and behaviour.

Clin Transl Immunology 2020 13;9(11):e1205. Epub 2020 Nov 13.

Department of Respiratory Sciences Institute for Lung Health University of Leicester Leicester UK.

Objectives: Airway hyper-responsiveness and persistent airflow obstruction contribute to asthma pathogenesis and symptoms, due in part to airway smooth muscle (ASM) hypercontractility and increased ASM mass. Fibrocytes have been shown to localise to the ASM in asthma however it is not known whether fibrocytes localise to the ASM in nonasthmatic eosinophilic bronchitis (NAEB) and chronic obstructive pulmonary disease (COPD). In addition, the potential consequences of fibrocyte localisation to ASM as regards asthma pathophysiology has not been widely studied.

Methods: Fibrocytes and proliferating cells were enumerated in ASM in bronchial tissue using immunohistochemistry. The effects of primary ASM and fibrocytes upon each other in terms of phenotype and behaviour following co-culture were investigated by assessing cell number, size, apoptotic status, phenotype and contractility in cell-based assays.

Results: Increased fibrocyte number in the ASM was observed in asthma versus NAEB, but not NAEB and COPD versus controls, and confirmed in asthma versus controls. ASM proliferation was not detectably different in asthmatics versus healthy controls . No difference in proliferation, apoptotic status or size of ASM was seen following culture with/without fibrocytes. Following co-culture with ASM from asthmatics versus nonasthmatics, fibrocyte smooth muscle marker expression and collagen gel contraction were greater. Following co-culture, fibrocyte CD14 expression was restored with the potential to contribute to asthma pathogenesis via monocyte-mediated processes dependent on the inflammatory milieu.

Conclusion: Further understanding of mechanisms of fibrocyte recruitment to and/or differentiation within the ASM may identify novel therapeutic targets to modulate ASM dysfunction in asthma.
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http://dx.doi.org/10.1002/cti2.1205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662089PMC
November 2020

Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers.

Int Q Community Health Educ 2021 Jul 3;41(4):411-418. Epub 2020 Nov 3.

Department of Exercise Science, Physical Activity Research Group, University of South Carolina, Columbia, South Carolina, United States.

Background: Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising -led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned.

Methods: Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and in a subsample of 12 families.

Results: recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity).

Conclusion: Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.
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http://dx.doi.org/10.1177/0272684X20970375DOI Listing
July 2021

Personal, Social, and Environmental Influences on Physical Activity in Groups of Children As Defined by Different Physical Activity Patterns.

J Phys Act Health 2020 Jul 30;17(9):867-873. Epub 2020 Jul 30.

Background: Interventions promoting physical activity (PA) in youth have had limited success, in part because studies with methodological challenges have yielded an incomplete understanding of personal, social, and environmental influences on PA. This study described changes in these factors for subgroups of youth with initially high PA that decreased (Active-Decline) compared with children with initially low PA that decreased (Inactive-Decline) from fifth to ninth grades.

Methods: Observational, prospective cohort design. Participants (n = 625) were fifth-grade children recruited in 2 school districts and followed from elementary to high school. Students and their parents responded to questionnaires to assess personal, social, and perceived physical environmental factors in the fifth (mean age = 10.5 [.5] y) and ninth (mean age = 14.7 [.6] y) grades. Analyses included a mixed-model 2-way repeated analysis of variances.

Results: Children in the Active-Decline compared with those in the Inactive-Decline group showed a more favorable profile in 6 of 8 personal variables (perceived barriers, self-efficacy, self-schema, enjoyment, competence, and fitness motives) and 4 of 6 social variables (friend support, parent encouragement, parent support, and parent-reported support).

Conclusions: The results suggest efforts to promote PA should target selected personal, social, and perceived environmental factors beginning before age 10 and continuing through adolescence.
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http://dx.doi.org/10.1123/jpah.2020-0159DOI Listing
July 2020

The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study: 24-Month Organizational Maintenance in a Countywide Initiative.

Front Public Health 2020 14;8:171. Epub 2020 May 14.

Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.

Despite the important role that faith-based organizations can play in eliminating health disparities, few studies have focused on organizational change and maintenance of interventions in this setting, making their long-term impact unknown. This study reports 24-month maintenance of the Faith, Activity, and Nutrition (FAN) program in a southeastern county. Previously reported findings of reach, adoption, implementation, and effectiveness are also summarized. Church coordinators from 35 intervention churches (97% predominantly African American) located in a rural, medically underserved county in South Carolina were interviewed at baseline (2015), and 12- and 24-months post-training regarding implementation of physical activity (PA) and healthy eating (HE) components of the FAN program. Guided by the RE-AIM framework, organizational maintenance was defined as church coordinator-reported 24-month implementation of the four FAN components (providing opportunities, setting guidelines/policies, sharing messages, engaging pastor). Repeated measures analyses (mixed models) examined change in implementation over time. Churches were also classified as maintainers, non-sustained implementers, and low implementers for each FAN component. Statistical analyses were conducted in 2019. Church coordinators reported significantly greater implementation of both PA and HE FAN components at 12 and 24 months compared to baseline (medium to large effects). The percentage of churches classified as maintainers ranged from 21 to 42 and 27 to 94% across PA and HE components, respectively. Most churches (58% for PA, 97% for HE) were maintaining at least one FAN component at 24 months. These promising findings position FAN well for the national implementation study now underway. This study is registered at www.clinicaltrials.gov NCT02868866.
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http://dx.doi.org/10.3389/fpubh.2020.00171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247868PMC
May 2021

ST2 expression and release by the bronchial epithelium is downregulated in asthma.

Allergy 2020 12 27;75(12):3184-3194. Epub 2020 Jul 27.

Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK.

Background: The airway epithelium plays an important role in wound repair, host defense and is involved in the immunopathogenesis of asthma. Genome wide association studies have described associations between ST2/Interleukin (IL)-33 genes in asthma, but its role in bronchial epithelium is unclear.

Methods: ST2 expression was examined in subjects with asthma and healthy controls in bronchial epithelium from biopsies (n = 27 versus n = 9) and brushings (n = 34 versus n = 20) by immunohistochemistry and RNA-Seq. In human primary bronchial epithelial cells ST2 mRNA and protein expression were assessed by qPCR, flow cytometry, Western blotting, and immunofluorescence. IL-33 function in epithelial cells was examined by intracellular calcium measurements, wound healing assays, and synthetic activation by gene array and ELISA.

Results: Bronchial epithelial ST2 protein expression was significantly decreased in biopsies in subjects with asthma compared to healthy controls (P = .039). IL1RL1 gene expression in bronchial brushes was not different between health and disease. In vitro primary bronchial epithelial cells expressed ST2 and IL-33 stimulation led to an increase in intracellular calcium, altered gene expression, but had no effect upon wound repair. Epithelial cells released sST2 spontaneously, which was reduced following stimulation with TNFα or poly-IC. Stimulation by TNFα or poly-IC did not affect the total ST2 expression by epithelial cell whereas surface ST2 decreased in response to TNFα, but not poly-IC.

Conclusion: In asthma, bronchial epithelium protein expression of ST2 is decreased. Our in vitro findings suggest that this decrease might be a consequence of the pro-inflammatory environment in asthma or in response to viral infection.
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http://dx.doi.org/10.1111/all.14436DOI Listing
December 2020

Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative.

Transl Behav Med 2021 03;11(2):419-429

South Carolina Conference of the United Methodist Church, Columbia, SC.

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.
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http://dx.doi.org/10.1093/tbm/ibaa025DOI Listing
March 2021

Longitudinal Associations Between Psychosocial, Home, and Neighborhood Factors and Children's Physical Activity.

J Phys Act Health 2020 03 1;17(3):306-312. Epub 2020 Mar 1.

Background: Physical activity (PA) provides important health benefits to children, and a large percentage of children's PA occurs at home. The purpose of this study was to examine the associations between psychosocial, home, and neighborhood environmental factors and children's reported PA at home and in the neighborhood, during the transition from elementary to high school.

Methods: A total of 555 participants (44% boys) were recruited in grade 5 and followed through grades 6, 7, and 9. Children self-reported PA in 3 locations-at home, in the neighborhood, and on the street. Children reported parent support and neighborhood environment, parents reported PA equipment, and a windshield survey assessed incivilities and outside PA equipment. Longitudinal Poisson models evaluated the relationships between environmental variables and 3 self-reported PA variables, adjusting for gender, race/ethnicity, and parent education.

Results: Parent support and PA equipment were significant positive predictors of home PA. Child's perceived environment (positive) and incivilities (negative) were significant predictors of neighborhood PA. Parental support, perceived environment, and outside PA equipment were positive significant predictors of street PA.

Conclusions: This study supports the need for both family and community/neighborhood PA interventions that encourage parents to support child PA and for communities to reduce incivilities.
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http://dx.doi.org/10.1123/jpah.2019-0137DOI Listing
March 2020

Childcare Center Characteristics Moderate the Effects of a Physical Activity Intervention.

Int J Environ Res Public Health 2019 12 22;17(1). Epub 2019 Dec 22.

Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Suite 212, Columbia, SC 29201, USA.

Center-based early childhood education and care (ECEC) programs are well-positioned to create positive impacts on the health and development of large numbers of young children by promoting physical activity using evidence-based programs. Studies testing physical activity programs for young children should examine the circumstances under which programs are most effective by assessing the role of contextual factors on program outcomes. The purpose of this study was to examine the moderating effects of baseline ECEC center characteristics on the relationship between the Study of Health and Activity in Preschool Environments (SHAPES) intervention and moderate-to-vigorous physical activity (MVPA). MVPA was assessed via accelerometry; center characteristics, practices, and social and physical environments were assessed by director interview and observation; and center quality was assessed using the Early Childhood Environment Rating Scale-Revised Edition. Mixed-model analyses of covariance (ANCOVAs) examined intervention effects on MVPA during the school day; interactions between baseline center variables and group assignment (intervention vs. control) tested for moderation. Two center instructional practices, two social environment characteristics, and one physical environment characteristic at baseline moderated the effects of SHAPES on MVPA outcomes. Assessing baseline practices and center characteristics may aid efforts to match centers with interventions likely to increase physical activity as well as suggest additional intervention strategies to test.
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http://dx.doi.org/10.3390/ijerph17010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6982193PMC
December 2019

Sport participation, physical activity and sedentary behavior in the transition from middle school to high school.

J Sci Med Sport 2020 Apr 1;23(4):385-389. Epub 2019 Nov 1.

Department of Exercise Science, Public Health Research Center, University of South Carolina, USA.

Objectives: To examine associations between sport participation, and objectively assessed physical activity and sedentary behavior in youth during the transition from middle school to high school.

Design: Longitudinal study with 2-year follow-up.

Methods: Sport participation and accelerometer-measured physical activity and sedentary behavior were assessed in 306 children (122 males, 184 females) when they were in 7th and 9th grades (mean age of 12.5 ± 0.5 years).

Results: Sport participation and physical activity declined from 7th to 9th grade, but total physical activity (d = 0.38, p < 0.0001) and moderate-to-vigorous physical activity (d = 0.26, p = 0.0004) remained higher in sport participants compared to non-participants. In 9th grade, the full sample of sport participants compared to non-participants had higher levels of total physical activity (20.7 min/h vs. 18.5 min/h) and moderate-to-vigorous physical activity (1.8 min/h vs. 1.6 min/h). Sex-specific analysis revealed similar patterns in both females and males. Sedentary behavior remained lower (d = -0.37, p = <0.0001) in the full sample of sport participants compared to non-participants (39.8 min/h vs. 41.7 min/h) in 9th grade. Similar patterns were observed in both females and males.

Conclusions: Children's participation in sport is associated with greater levels of physical activity and lower levels of sedentary behavior during the transition from middle school to high school. Promoting children's participation in sports could be an effective public health strategy to help children meet the current physical activity guideline.
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http://dx.doi.org/10.1016/j.jsams.2019.10.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054172PMC
April 2020

Role of Organizational Support on Implementation of an Environmental Change Intervention to Improve Child Fruit and Vegetable Intake: a Randomized Cross-Over Design.

Prev Sci 2019 11;20(8):1211-1218

Division of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Austin, TX, USA.

Little is known about the role of organizational or administrative support in implementation of health promotion interventions, particularly outside of school settings. The purpose was to determine the change in fruit and vegetable (FV) intake among children living in residential children's homes (RCHs) and assess the relationships among change in organizational support, intervention implementation, and child nutrition outcomes. Data were collected from 29 RCHs and 614 children living in RCHs, as part of a group randomized design with delayed intervention, at three cross-sectional waves: 2004, 2006, and 2008. RCH staff made environmental changes to increase intake of FV. Implementation and organizational support data were collected from staff at the RCHs. Child FV intake were measured via 24-h dietary recalls. A two-way (condition by time) repeated measures ANOVA was conducted to test whether FV intake increased in response to the intervention. A two-level path analysis with a robust maximum likelihood estimator was used to explore the relationships among organizational support, intervention implementation fidelity, and child FV intake. There was a significant increase in FV intake within all RCHs from 2004 to 2006 (P = 0.022 for the intervention group, P = 0.015 for the control group). This increase was maintained in both groups from 2006 to 2008 (post-intervention mean servings: intervention = 3.2 vs control = 3.4). Increases in organizational support resulted in greater overall implementation fidelity. When RCH staff, supervisors, and the RCH CEO were perceived to be supportive of the intervention, more environmental changes were made to encourage eating FV. Fostering organizational support may improve implementation of interventions.
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http://dx.doi.org/10.1007/s11121-019-01043-zDOI Listing
November 2019

The translation of an evidence-based preschool physical activity intervention from in-person to online delivery of professional development to preschool teachers.

Transl Behav Med 2019 11;9(6):1186-1196

Department of Exercise Science, Public Health Research Center, University of South Carolina, Columbia, SC, USA.

Study of Health and Activity in Preschool Environments (SHAPES) aimed to increase preschoolers' physical activity by engaging preschool teachers in professional development designed to modify instructional practices. SHAPES originated as a randomized controlled trial, tested in 16 preschools and disseminated to 4 control schools, and was shown to be effective in increasing preschool children's physical activity (Phase I, 2008-2012). This article describes the steps taken to translate an evidence-based physical activity intervention, SHAPES, from in-person delivery to online delivery of professional development to preschool teachers. In Phase II (2013-2016), professional development delivery was modified from an in-person to an online program for preschool teachers. Teacher implementation completeness and fidelity were examined in 10 pilot preschools and then replicated in 30 preschools. Large-scale dissemination of SHAPES began in Phase III (2017-2019), reaching 818 teachers from 228 unique centers after 2 years. The final SHAPES program consisted of six online modules, an accompanying guidebook, over 90 activities, self-assessment techniques, a video library, and an electronic community forum. The SHAPES core elements, defined in Phase I, were retained throughout all three phases. The Phase II change to online delivery was characterized by high levels of implementation completeness and fidelity. Results of Phase III statewide dissemination revealed comparable implementation completeness and fidelity. An intervention shown to be effective in a randomized controlled trial can be translated into an online professional development program and disseminated on a large scale in a timely manner.
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http://dx.doi.org/10.1093/tbm/ibz076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875643PMC
November 2019

Evaluation of a comprehensive school physical activity program: Be a Champion!

Eval Program Plann 2019 08 2;75:54-60. Epub 2019 May 2.

Department of Family & Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA; Department of Epidemiology & Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA; Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA. Electronic address:

Background: Comprehensive School Physical Activity Programs (CSPAPs) are widely supported to increase physical activity (PA) in schools, but little has been reported to inform a comprehensive evaluation effort. The purpose of this report is to describe a comprehensive evaluation and monitoring strategy for CSPAP implementation.

Methods: The System for Observing Staff Promotion of Activity and Nutrition (SOSPAN), System for Observing Student Movement in Academic Routines and Transitions (SOSMART), and System for Observing Play and Leisure Activity (SOPLAY) were employed to record student and staff behaviors (2642 total scans). To assess policies, practices, and environments, a CSPAP Policies and Practices questionnaire was used, which included components of the School Health Index, the School PA Policy Assessment, the School Environment and Policies Survey, and the School Health Policies and Practices Study. Youth PA (minutes/day) was assessed using accelerometers.

Results: Working with school sites to ascertain the number of opportunities that are provided for PA and the amount of PA students engage in is challenging but feasible. The use of systematic observation, accelerometers, and questionnaires can provide a comprehensive representation of policies, practices, and behaviors to aid in establishing targeted PA action items.

Conclusions: Developing an evaluation framework that was rigorous enough to assess the physical, social, and policy environment of a school in order to answer the overarching research questions of the study but flexible enough to be feasibly streamlined for utilization by a school implementation team proved to be challenging but possible.
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http://dx.doi.org/10.1016/j.evalprogplan.2019.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258480PMC
August 2019

Self-efficacy, beliefs, and goals: Moderation of declining physical activity during adolescence.

Health Psychol 2019 Jun 11;38(6):483-493. Epub 2019 Apr 11.

Department of Exercise Science.

Objective: To examine whether the decline in physical activity observed from childhood through adolescence is explained by moderating effects of self-efficacy on concurrent changes in children's goals and beliefs about their physical activity environments.

Method: Latent growth modeling was used in longitudinal tests in a cohort of 79 boys and 108 girls assessed in 5th, 6th, 7th, 9th, and 11th grades.

Results: Physical activity measured objectively by an accelerometer declined most in students who had bigger declines in self-efficacy and (1) maintained higher perceptions of barriers to physical activity, (2) had bigger declines in enjoyment and fitness goals, or (3) had smaller declines in appearance and social goals.

Conclusions: Trials of physical activity interventions based on social-cognitive theory should consider that the influence of changing goals on physical activity may differ according to whether students maintain high efficacy beliefs about overcoming barriers to physical activity coincident with perceptions of their physical activity environment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522322PMC
June 2019

DP antagonism reduces airway smooth muscle mass in asthma by decreasing eosinophilia and myofibroblast recruitment.

Sci Transl Med 2019 02;11(479)

University of Leicester, Leicester LE3 9QP, UK.

Increased airway smooth muscle mass, a feature of airway remodeling in asthma, is the strongest predictor of airflow limitation and contributes to asthma-associated morbidity and mortality. No current drug therapy for asthma is known to affect airway smooth muscle mass. Although there is increasing evidence that prostaglandin D type 2 receptor (DP) is expressed in airway structural and inflammatory cells, few studies have addressed the expression and function of DP in airway smooth muscle cells. We report that the DP antagonist fevipiprant reduced airway smooth muscle mass in bronchial biopsies from patients with asthma who had participated in a previous randomized placebo-controlled trial. We developed a computational model to capture airway remodeling. Our model predicted that a reduction in airway eosinophilia alone was insufficient to explain the clinically observed decrease in airway smooth muscle mass without a concomitant reduction in the recruitment of airway smooth muscle cells or their precursors to airway smooth muscle bundles that comprise the airway smooth muscle layer. We experimentally confirmed that airway smooth muscle migration could be inhibited in vitro using DP-specific antagonists in an airway smooth muscle cell culture model. Our analyses suggest that fevipiprant, through antagonism of DP, reduced airway smooth muscle mass in patients with asthma by decreasing airway eosinophilia in concert with reduced recruitment of myofibroblasts and fibrocytes to the airway smooth muscle bundle. Fevipiprant may thus represent a potential therapy to ameliorate airway remodeling in asthma.
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http://dx.doi.org/10.1126/scitranslmed.aao6451DOI Listing
February 2019

Change in Children's Physical Activity: Predictors in the Transition From Elementary to Middle School.

Am J Prev Med 2019 03 15;56(3):e65-e73. Epub 2019 Jan 15.

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

Introduction: Interventions to promote physical activity in children should be informed by knowledge of the factors that influence physical activity behavior during critical developmental transitions. The purpose of this study is to identify, from a comprehensive, multidomain set of factors, those that are associated with change in objectively measured physical activity in children as they transition from elementary to middle school.

Methods: The study used a prospective cohort design, with children observed in fifth, sixth, and seventh grades. Growth curve analyses were used to examine associations between exposure variables measured at baseline and children's physical activity across three observations. A total of 828 children, aged 10.6 (SD=0.5) years at baseline provided physical activity data in fifth grade and at one or both follow-ups. Exposure variables assessed child characteristics, parent characteristics, home characteristics, social factors, school environment, and community characteristics. Physical activity was measured via accelerometry. Data were collected in two school districts in South Carolina in 2010-2013 and analyzed in 2017.

Results: Variables measured within the child, parent/home, and community domains were positively associated with children's physical activity as they transitioned from fifth to seventh grade. These included parent encouragement of physical activity, parental support for physical activity, child sports participation, parent's report of the child's physical activity level, the child's time spent outdoors, social spaces for physical activity in the community, and the number of physical activity facilities that were proximal to the child's home.

Conclusions: Interventions designed to increase children's physical activity should include strategies that target multiple domains of influence.
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http://dx.doi.org/10.1016/j.amepre.2018.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380938PMC
March 2019

The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results.

Health Educ Behav 2019 06 21;46(3):388-397. Epub 2018 Dec 21.

1 University of South Carolina, Columbia, SC, USA.

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention ( n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN.
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http://dx.doi.org/10.1177/1090198118818235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199798PMC
June 2019

Advancing health promotion through massage therapy practice: A cross-sectional survey study.

Prev Med Rep 2018 Sep 11;11:49-55. Epub 2018 May 11.

Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, USA.

The human resources needed to provide health promotion services to improve health behaviors in populations are currently limited. Health promotion and education is included in the definition of massage therapy, and many within the massage therapy profession understand that health promotion and education are a part of massage therapy practice. However, the amounts and types of health promotion activities in massage therapy practice have not been thoroughly explored. The objective of this study was to investigate the current attitudes, practices, and barriers toward providing health promotion in a national sample of practicing massage therapists. A descriptive cross-sectional survey disseminated May to August 2016 to practicing massage therapists in the United States. The majority (90.2%) of the 182 participants agree or strongly agree that it is important for massage therapists to provide health promotion. Therapists with less favorable attitudes about providing health promotion reported more barriers to providing the messages to their patients. Barriers to providing health promotion included a lack of guidelines, knowledge, and skills. Training and guidelines for massage therapists regarding health promotion would be a reasonable next step for future research development. Utilizing massage therapists as health promoters may provide opportunities to deliver more prevention messages to patients which may impact public health.
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http://dx.doi.org/10.1016/j.pmedr.2018.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030570PMC
September 2018

Statewide dissemination and implementation of physical activity standards in afterschool programs: two-year results.

BMC Public Health 2018 07 3;18(1):819. Epub 2018 Jul 3.

University of Kentucky, Lexington, KY, USA.

Background: In 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard.

Methods: Twenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N = 97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Intent-to-treat (ITT) models were conducted summer 2017. Programs were also classified, based on changes in MVPA from 2015 to 2016 and 2016-2017, into one of three categories: gain, maintain, or lost. Implementation, within the three groups, was evaluated via direct observation and document review.

Results: Adoption during the first year was 45% of staff attending training, with this increasing to 67% of staff during the second year. ITT models indicated no increase in the odds of accumulating 30 min of MVPA after the first year for either boys (odds ratio [OR] 1.06, 95CI 0.86-1.31) or girls (OR 1.14, 95CI 0.87-1.50), whereas an increase in the odds was observed during the second year for boys (OR 1.31, 95CI 1.04-1.64) and girls (OR 1.50 95CI 1.01-1.80). Programs that lost MVPA (avg. - 5 to - 7.5 min/d MVPA) elected to modify their program in a greater number of non-supportive ways (e.g., reduce time for activity opportunities, less time spent outdoors), whereas ASPs that gained MVPA (avg. + 5.5 to + 10.1 min MVPA) elected to modify their program in more supportive ways.

Conclusions: The statewide study demonstrated minimal improvements in overall MVPA. However, child MVPA was dramatically influenced by ASPs who elected to modify their daily program in more supportive than non-supportive ways, with no one program modifying their program consistently across the multi-year initiative. These findings have important implications for organizations seeking to achieve the MVPA standard.

Trial Registration: Clinical Trial Registration: NCT02394717 .
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http://dx.doi.org/10.1186/s12889-018-5737-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029349PMC
July 2018

, and study challenges the impact of bronchial thermoplasty on acute airway smooth muscle mass loss.

Eur Respir J 2018 05 24;51(5). Epub 2018 May 24.

Dept of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.

Bronchial thermoplasty is a treatment for asthma. It is currently unclear whether its histopathological impact is sufficiently explained by the proportion of airway wall that is exposed to temperatures necessary to affect cell survival.Airway smooth muscle and bronchial epithelial cells were exposed to media (37-70°C) for 10 s to mimic thermoplasty. we developed a mathematical model of airway heat distribution post-thermoplasty. we determined airway smooth muscle mass and epithelial integrity pre- and post-thermoplasty in 14 patients with severe asthma. airway smooth muscle and epithelial cell number decreased significantly following the addition of media heated to ≥65°C. simulations showed a heterogeneous heat distribution that was amplified in larger airways, with <10% of the airway wall heated to >60°C in airways with an inner radius of ∼4 mm. at 6 weeks post-thermoplasty, there was an improvement in asthma control (measured Asthma Control Questionnaire-6; mean difference 0.7, 95% CI 0.1-1.3; p=0.03), airway smooth muscle mass decreased (absolute median reduction 5%, interquartile range (IQR) 0-10; p=0.03) and epithelial integrity increased (14%, IQR 6-29; p=0.007). Neither of the latter two outcomes was related to improved asthma control.Integrated and modelling suggest that the reduction in airway smooth muscle post-thermoplasty cannot be fully explained by acute heating, and nor did this reduction confer a greater improvement in asthma control.
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http://dx.doi.org/10.1183/13993003.01680-2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003767PMC
May 2018

Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness.

Am J Prev Med 2018 06 12;54(6):776-785. Epub 2018 Apr 12.

Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.

Introduction: Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study.

Design: This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017.

Setting/participants: Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated).

Intervention: Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance.

Main Outcomes Measures: The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis.

Results: Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group.

Conclusions: This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination.

Trial Registration: This study is registered at www.clinicaltrials.gov NCT02868866.
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http://dx.doi.org/10.1016/j.amepre.2018.02.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203293PMC
June 2018

Physical and Social Contexts of Physical Activity Behaviors of Fifth and Seventh Grade Youth.

J Sch Health 2018 02;88(2):122-131

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208.

Background: The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade.

Methods: Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5-day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time.

Results: Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from "both inside/outside" to "outside" school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades.

Conclusions: Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex-specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well-positioned to provide additional physical activity opportunities.
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http://dx.doi.org/10.1111/josh.12587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599639PMC
February 2018

Evaluation of a statewide dissemination and implementation of physical activity intervention in afterschool programs: a nonrandomized trial.

Transl Behav Med 2017 12;7(4):690-701

Medical University of South Carolina, Charleston, SC, USA.

In 2015, YMCA-operated afterschool programs (ASPs) across South Carolina pledged to achieve the national standard that calls for every child to accumulate 30 min/day of moderate-to-vigorous physical activity (MVPA) during program time. This study shares the first-year findings related to the dissemination, implementation, and outcomes associated with the statewide intervention to achieve the MVPA Standard. Twenty ASPs were sampled from all YMCA-operated ASPs (N = 97) and visited at baseline (spring 2015) and first-year follow-up (spring 2016). Programs were provided standardized professional development training to increase the MVPA children accumulated while attending ASPs. The training focused on extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Implementation was evaluated via direct observation. Intent-to-treat (ITT) and as-treated comparisons were conducted in summer 2016. Reach/adoption was variable, with attendance at trainings ranging from 0 to 100% across ASPs. Effectiveness of the intervention using ITT models indicated no changes from baseline in the percentage of programs meeting the MVPA standard for boys or girls. Implementation levels also varied and were related to increases in both boys' and girls' MVPA for moderate and high implementers. Findings indicate improvements in MVPA can be made from attending the trainings and implementing some or all of the training components. Additional work is necessary to identify ways to ensure staff attend trainings to implement strategies and to identify which specific factors contributed to increases in MVPA.
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http://dx.doi.org/10.1007/s13142-017-0484-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684072PMC
December 2017

HMGB1 is upregulated in the airways in asthma and potentiates airway smooth muscle contraction via TLR4.

J Allergy Clin Immunol 2017 08 1;140(2):584-587.e8. Epub 2017 Mar 1.

Institute for Lung Health, Department of Infection, Immunity & Inflammation, Glenfield Hospital, University of Leicester, Leicester, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jaci.2016.11.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540224PMC
August 2017

Naturally-occurring changes in social-cognitive factors modify change in physical activity during early adolescence.

PLoS One 2017 10;12(2):e0172040. Epub 2017 Feb 10.

Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America.

Purpose: To determine whether naturally-occurring changes in children's motives and beliefs are associated with the steep decline in physical activity observed from childhood to early adolescence.

Methods: Latent growth modeling was applied in longitudinal tests of social-cognitive influences, and their interactions, on physical activity in a large cohort of boys and girls evaluated annually between 5th and 7th grades.

Results: Measurement equivalence of motives and beliefs was confirmed between boys and girls. After adjustment for gender and maturity differences, physical activity declined less in children who reported the least decreases in self-efficacy for overcoming barriers to activity and perceived parental support. Physical activity also declined less in students who persistently felt they had more parental and friend support for activity compared to those who reported the largest decrease in support from friends. After further adjustment for race, the decline in physical activity was less in those who had the largest decrease in perceived barriers and maintained a favorable perception of their neighborhood environment. Changes in enjoyment and social motives were unrelated to change in physical activity.

Conclusion: Using an objective measure of physical activity, we confirm that naturally-occurring changes in children's beliefs about barriers to physical activity and their ability to overcome them, as well as perceptions of their neighborhood environment and social support, are concurrent with age-related declines in children's physical activity. The longitudinal findings confirm these putative social-cognitive mediators as plausible, interacting targets of interventions designed to mitigate the marked decline in physical activity that occurs during the transition between elementary and middle schools.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172040PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5302819PMC
August 2017

Factors influencing implementation of a preschool-based physical activity intervention.

Health Educ Res 2017 02;32(1):69-80

Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA and.

Examining factors that influence implementation of key program components that underlie an intervention’s success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40 min of outdoor recess per day), that was fundamental to the success of a preschool-based physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected from surveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (β= 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time.
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http://dx.doi.org/10.1093/her/cyw053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5914442PMC
February 2017
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