Objective: This study examines the associa- tions between objectively measured physical activity ... more Objective: This study examines the associa- tions between objectively measured physical activity and cardiovascular disease (CVD) risk factors in preadolescent African American girls. Methods: We conducted a cross-sectional analysis of data from Stanford Girls Health Enrichment Multisite Studies (GEMS) trial. Physical activity was assessed for four days by using an ActiGraph accelerometer and was correlated with anthropometric measures, blood pressure,
Advances in information technology and near ubiquity of the Internet have spawned novel modes of ... more Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was with...
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2007
A randomized controlled pilot study to test the hypothesis that increasing preschool children'... more A randomized controlled pilot study to test the hypothesis that increasing preschool children's outdoor free play time increases their daily physical activity levels. Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children (3.6+/-0.5 years) attending a preschool for low-income families. After two days of baseline physical activity assessment, participants were randomly assigned to an intervention (RECESS; n =17) or control (CON; n =15) group. The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days. The CON group followed their normal classroom schedule. Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test. There were no statistically significant differences between groups in changes from baseline in average total daily (CON, 48.2+/-114.5; RECESS, 58.2+/-74.6) and during school day (CON, 64.6+/-181.9; RECESS, 59.7+/-79.1) counts p...
To test the feasibility, acceptability, and potential efficacy of after-school dance classes and ... more To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls. Twelve-week, 2-arm parallel group, randomized controlled trial. Low-income neighborhoods. Sixty-one 8-10-year-old African-American girls and their parents/guardians. The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures. Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV. Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and ...
Community-based prospective studies are needed to shed light on mechanisms that may influence dev... more Community-based prospective studies are needed to shed light on mechanisms that may influence development of eating disorders and identify variables that could serve as potential targets for prevention efforts. In this paper we examine level of weight preoccupation and other variables prospectively associated with age of onset of eating disorder symptoms over a 3-year interval in a community sample (N = 939) of young adolescent girls. 3.6% (32/887) experienced onset of symptoms over the interval. Only one factor, a measure of Weight Concerns, was significantly associated with onset (p < .001). Girls scoring in the highest quartile on the measure of Weight Concerns had the shortest survival time (12% incidence by age 14.5) and those scoring in the lowest quartile had the highest survival time (2% incidence by age 14.5; p < .001). This finding is consistent with both theoretical and clinical perspectives and represents one of the first prospective demonstrations of a linkage between weight and body shape concerns and later onset of eating disorder symptoms. An understanding of the independent variables that predispose girls to development of symptoms is a useful step towards the establishment of a rational basis for the choice of a prevention intervention target.
To examine the current status of interactive health communication (IHC) and propose evidence-base... more To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.
This study was designed to create, implement, and test a school-based multiple risk factor reduct... more This study was designed to create, implement, and test a school-based multiple risk factor reduction program for high school students. All tenth graders in four senior high schools (N = 1447) from two school districts participated in the study. Within each district, one school was assigned at random to receive a special 20-session CVD risk reduction intervention and one school served as a control. The schools were matched for size and distribution of racial groups before randomization. At a two-month follow-up, knowledge gains were significantly greater for students in the treatment group on each of the risk factor domains tested: nutrition/diet (p less than 0.0001), physical activity (p less than 0.0001), and cigarette smoking (p less than 0.0001). Compared to controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline, reported regular exercise at follow-up (p less than 0.0003). Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared to 10.3% in the control group (p = 0.009). Students in the treatment group were more likely to report that they would choose heart healthy snack items (p less than 0.0001). Beneficial treatment effects were observed for resting heart rate (p less than 0.0001), BMI (p = 0.05), triceps skinfold thickness (p = 0.003), and subscapular skinfold thickness (p = 0.01). The results suggest that it is feasible to provide CVD risk reduction training to a large segment of the population through school-based primary prevention approaches.
The purpose of this study was to develop a data-driven approach for analyzing incomplete accelero... more The purpose of this study was to develop a data-driven approach for analyzing incomplete accelerometer data from field-base studies. Multiple days of accelerometer data from the Stanford Girls health Enrichment Multi-site Studies (N = 294 African American girls) were summed across each minute of each day to produce a composite weekday and weekend day. Composite method estimates of physical activity were compared with those derived from methods typically described in the literature (comparison methods). The composite method retained 99.7% and 100% of participants in weekday and weekend-day analysis, respectively, versus 84.7% to 94.2% and 28.6% to 99.0% for the comparison methods. Average wearing times for the composite method for weekday and weekend day were 99.6% and 98.6%, respectively, 91.7% to 93.9% and 82.3% to 95.4% for the comparison methods. Composite-method physical activity estimates were similar to comparison-methods estimates. The composite method used more available accelerometer data than standard approaches, reducing the need to exclude periods within a day, entire days, and participants from analysis.
Journal of Consulting and Clinical Psychology, 1997
Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of te... more Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of teenagers (N = 1,901). Students in Cohort 1 were followed over 4 years from 9th to 12th grade; those in Cohort 2 were followed over 3 years from 9th to 11th grade. Among girls with no history of smoking at baseline, those with more friends who smoked at baseline (p < .001) and those with higher sociability scores (p < .05) were significantly more likely to have tried smoking over the study interval. Among boys with no history of smoking at baseline, those with more friends who smoked at baseline (p < .05) and those with higher depression symptoms scores (p < .01) were significantly more likely to have tried smoking over the study interval. The data suggest that future research is needed to examine potential gender differences that may have implications for the next generation of smoking-prevention programs.
Objective: This study examines the associa- tions between objectively measured physical activity ... more Objective: This study examines the associa- tions between objectively measured physical activity and cardiovascular disease (CVD) risk factors in preadolescent African American girls. Methods: We conducted a cross-sectional analysis of data from Stanford Girls Health Enrichment Multisite Studies (GEMS) trial. Physical activity was assessed for four days by using an ActiGraph accelerometer and was correlated with anthropometric measures, blood pressure,
Advances in information technology and near ubiquity of the Internet have spawned novel modes of ... more Advances in information technology and near ubiquity of the Internet have spawned novel modes of communication and unprecedented insights into human behavior via the digital footprint. Health behavior randomized controlled trials (RCTs), especially technology-based, can leverage these advances to improve the overall clinical trials management process and benefit from improvements at every stage, from recruitment and enrollment to engagement and retention. In this paper, we report the results for recruitment and retention of participants in the SMART study and introduce a new model for clinical trials management that is a result of interdisciplinary team science. The MARKIT model brings together best practices from information technology, marketing, and clinical research into a single framework to maximize efforts for recruitment, enrollment, engagement, and retention of participants into a RCT. These practices may have contributed to the study's on-time recruitment that was with...
International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity, 2007
A randomized controlled pilot study to test the hypothesis that increasing preschool children'... more A randomized controlled pilot study to test the hypothesis that increasing preschool children's outdoor free play time increases their daily physical activity levels. Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children (3.6+/-0.5 years) attending a preschool for low-income families. After two days of baseline physical activity assessment, participants were randomly assigned to an intervention (RECESS; n =17) or control (CON; n =15) group. The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days. The CON group followed their normal classroom schedule. Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test. There were no statistically significant differences between groups in changes from baseline in average total daily (CON, 48.2+/-114.5; RECESS, 58.2+/-74.6) and during school day (CON, 64.6+/-181.9; RECESS, 59.7+/-79.1) counts p...
To test the feasibility, acceptability, and potential efficacy of after-school dance classes and ... more To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls. Twelve-week, 2-arm parallel group, randomized controlled trial. Low-income neighborhoods. Sixty-one 8-10-year-old African-American girls and their parents/guardians. The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures. Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV. Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and ...
Community-based prospective studies are needed to shed light on mechanisms that may influence dev... more Community-based prospective studies are needed to shed light on mechanisms that may influence development of eating disorders and identify variables that could serve as potential targets for prevention efforts. In this paper we examine level of weight preoccupation and other variables prospectively associated with age of onset of eating disorder symptoms over a 3-year interval in a community sample (N = 939) of young adolescent girls. 3.6% (32/887) experienced onset of symptoms over the interval. Only one factor, a measure of Weight Concerns, was significantly associated with onset (p < .001). Girls scoring in the highest quartile on the measure of Weight Concerns had the shortest survival time (12% incidence by age 14.5) and those scoring in the lowest quartile had the highest survival time (2% incidence by age 14.5; p < .001). This finding is consistent with both theoretical and clinical perspectives and represents one of the first prospective demonstrations of a linkage between weight and body shape concerns and later onset of eating disorder symptoms. An understanding of the independent variables that predispose girls to development of symptoms is a useful step towards the establishment of a rational basis for the choice of a prevention intervention target.
To examine the current status of interactive health communication (IHC) and propose evidence-base... more To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.
This study was designed to create, implement, and test a school-based multiple risk factor reduct... more This study was designed to create, implement, and test a school-based multiple risk factor reduction program for high school students. All tenth graders in four senior high schools (N = 1447) from two school districts participated in the study. Within each district, one school was assigned at random to receive a special 20-session CVD risk reduction intervention and one school served as a control. The schools were matched for size and distribution of racial groups before randomization. At a two-month follow-up, knowledge gains were significantly greater for students in the treatment group on each of the risk factor domains tested: nutrition/diet (p less than 0.0001), physical activity (p less than 0.0001), and cigarette smoking (p less than 0.0001). Compared to controls, a higher proportion of those in the treatment group who were not exercising regularly at baseline, reported regular exercise at follow-up (p less than 0.0003). Almost twice as many baseline experimental smokers in the treatment group reported quitting at follow-up while only 5.6% of baseline experimental smokers in the treatment group graduated to regular smoking compared to 10.3% in the control group (p = 0.009). Students in the treatment group were more likely to report that they would choose heart healthy snack items (p less than 0.0001). Beneficial treatment effects were observed for resting heart rate (p less than 0.0001), BMI (p = 0.05), triceps skinfold thickness (p = 0.003), and subscapular skinfold thickness (p = 0.01). The results suggest that it is feasible to provide CVD risk reduction training to a large segment of the population through school-based primary prevention approaches.
The purpose of this study was to develop a data-driven approach for analyzing incomplete accelero... more The purpose of this study was to develop a data-driven approach for analyzing incomplete accelerometer data from field-base studies. Multiple days of accelerometer data from the Stanford Girls health Enrichment Multi-site Studies (N = 294 African American girls) were summed across each minute of each day to produce a composite weekday and weekend day. Composite method estimates of physical activity were compared with those derived from methods typically described in the literature (comparison methods). The composite method retained 99.7% and 100% of participants in weekday and weekend-day analysis, respectively, versus 84.7% to 94.2% and 28.6% to 99.0% for the comparison methods. Average wearing times for the composite method for weekday and weekend day were 99.6% and 98.6%, respectively, 91.7% to 93.9% and 82.3% to 95.4% for the comparison methods. Composite-method physical activity estimates were similar to comparison-methods estimates. The composite method used more available accelerometer data than standard approaches, reducing the need to exclude periods within a day, entire days, and participants from analysis.
Journal of Consulting and Clinical Psychology, 1997
Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of te... more Risk factors for the initiation of cigarette smoking were examined in 2 consecutive cohorts of teenagers (N = 1,901). Students in Cohort 1 were followed over 4 years from 9th to 12th grade; those in Cohort 2 were followed over 3 years from 9th to 11th grade. Among girls with no history of smoking at baseline, those with more friends who smoked at baseline (p < .001) and those with higher sociability scores (p < .05) were significantly more likely to have tried smoking over the study interval. Among boys with no history of smoking at baseline, those with more friends who smoked at baseline (p < .05) and those with higher depression symptoms scores (p < .01) were significantly more likely to have tried smoking over the study interval. The data suggest that future research is needed to examine potential gender differences that may have implications for the next generation of smoking-prevention programs.
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