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  • Author: Deborah Parra-Medina x
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Sara Wilcox, Deborah Parra-Medina, Gwen M. Felton, Mary Beth Poston and Amanda McClain

Background:

Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.

Methods:

Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.

Results:

Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.

Conclusions:

A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.

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Daniel R. Taber, June Stevens, Leslie A. Lytle, Robyn D. Foreman, Jamie Moody, Deborah Parra-Medina and Charlotte A. Pratt

Background:

Some researchers have questioned if activity programs would be more effective if based outside school (eg, community leagues) rather than within schools. This study compared participation in activity programs based within and outside of school, and estimated the associations between participation and moderate-vigorous physical activity (MVPA) among adolescent girls.

Methods:

Within the Trial of Activity for Adolescent Girls, independent samples of 1559 6th-grade girls (age 11 to 12) and 3282 8th-grade girls (age 13 to 14) reported program participation using questionnaires. MVPA was measured using accelerometers. Linear mixed models accounted for school and site clustering.

Results:

Sixth-grade girls reported 5 times as many programs outside school as within school (4.1 vs. 0.8); daily MVPA was 0.29 minutes higher (1.2% of the mean) for each additional program outside school. Compared with 6th-grade girls, 8th-grade girls participated in 1.3 fewer programs outside school, while programs’ association with MVPA was unchanged. Conversely, school programs’ association with MVPA was greater in 8th grade. Daily MVPA was 1.33 minutes higher per school program, and participation declined 0.13.

Conclusion:

Programs within and outside schools can both increase activity among adolescent girls. Intervention research should focus on increasing participation in school programs, and increasing movement during programs outside school.

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Patricia A. Sharpe, Sara Wilcox, Laura J. Rooney, Donna Strong, Rosie Hopkins-Campbell, Jean Butel, Barbara Ainsworth and Deborah Parra-Medina

Background:

Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations.

Methods:

Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, tailoring the message to the participant population, and creating a nonjudgmental environment.

Results:

Sixty women asked to wear the Actigraph GT1M returned the accelerometer, and 57 of them provided sufficient data for analysis (at least 10 hours a day for a minimum of 4 days) resulting in 95% adherence to the protocol. Participants wore the accelerometers for an average of 5.98 days and 13.15 hours per day.

Conclusions:

The high accelerometer monitoring adherence among this group of economically disadvantaged women demonstrates that collection of high-quality, objective physical activity data from disadvantaged populations in field-based research is possible.

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Melissa Bopp, Sara Wilcox, Marilyn Laken, Steven P. Hooker, Deborah Parra-Medina, Ruth Saunders, Kimberly Butler, Elizabeth A. Fallon and Lottie McClorin

Background:

Physical activity (PA) participation offers many benefits especially among ethnic groups that experience health disparities. Partnering with faith-based organizations allows for a more culturally tailored approach to changing health behaviors.

Methods:

8 Steps to Fitness was a faith-based behavior-change intervention promoting PA among members of African American churches. A quasi-experimental design was used to examine differences between the intervention group (n=72) and comparison group (n = 74). Health (resting blood pressure, body mass index, waist-hip ratio, fasting blood glucose), psycho-social (PA self-efficacy, social support, enjoyment, self-regulation, depression), and behavioral variables (PA, diet) were assessed at baseline, 3- and 6-months. Repeated measures ANCOVAs tested changes across time between groups.

Results:

At 3-months, the intervention group showed significantly more favorable changes in body mass index, waist circumference and social support than the control group. At 6-months, the intervention group showed significantly more favorable changes in hip circumference, waist to hip ratio, systolic blood pressure, and depressive symptoms. There was notable attrition from both the intervention (36%) and the comparison group (58%).

Conclusions:

This study was conducted in a real-world setting, and provided insight into how to deliver a culturally-tailored PA intervention program for African Americans with a potential for dissemination.

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Evelyn B. Kelly, Deborah Parra-Medina, Karin A. Pfeiffer, Marsha Dowda, Terry L. Conway, Larry S. Webber, Jared B. Jobe, Scott Going and Russell R. Pate

Background:

A need exists to better understand multilevel influences on physical activity among diverse samples of girls. This study examined correlates of moderate-to-vigorous physical activity (MVPA) among adolescent girls from different racial/ethnic backgrounds.

Methods:

1,180 6th grade girls (24.5% black, 15.7% Hispanic, and 59.8% white) completed a supervised self-administered questionnaire that measured hypothesized correlates of PA. MVPA data were collected for 6 days using the ActiGraph accelerometer. Hierarchical regression analysis was used to examine correlates of PA in each racial/ethnic group.

Results:

Hispanic girls (n = 185) engaged in 21.7 minutes of MVPA per day, black girls (n = 289) engaged in 19.5 minutes of MVPA per day, and white girls (n = 706) engaged in 22.8 minutes of MVPA per day. Perceived transportation barriers (+; P = .010) were significantly and positively related to MVPA for Hispanic girls. For black girls, Body Mass Index (BMI) (–; P = .005) and social support from friends (+; P = .006) were significant correlates of MVPA. For white girls, BMI (–; P < .001), barriers (–; P = .012), social support from friends (+; P = .010), participation in school sports (+; P = .009), and community sports (+; P = .025) were significant correlates of MVPA. Explained variance ranged from 30% to 35%.

Conclusions:

Correlates of MVPA varied by racial/ethnic groups. Effective interventions in ethnically diverse populations may require culturally tailored strategies.

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Patti L. Williams, Roger G. Sargent, Robert F. Valois, J. Wanzer Drane, Deborah M. Parra-Medina and Larry J. Durstine

This study is an examination of eating behaviors and body image concerns among 587 female collegiate athletes from nine colleges/universities representing 14 different sports. Measures included the Eating Disorders Inventory-2 (EDI-2), the Eating Attitudes Test (EAT-26), and a questionnaire gathering general demographic information, reasons for dieting and/or using other methods of weight control, as well as information about expressed concerns from others regarding the respondents weight. Three sport groups were hypothesized to be at increased risk: athletes whose performance is subjectively scored; athletes who compete in a sport where a low body weight is considered advantageous; and athletes who must wear body conrevealing clothing. Chi-Square and Logistic Regression analyses revealed no association between these sport groups and the presence of a subclinical eating disorder (SED). Additional analyses determined no statistical association between student-athletes competing at the National Collegiate Athletic Association Division I level (versus Division II or III level) or student-athletes who were scholarship recipients (versus non-scholarship recipients) and the presence of SED. Student-athletes who have heard expressed concerns from others regarding their body weight were significantly more likely to report the presence of SED (p < .0001). Therefore, special care should be taken with all student-athletes when discussing body weight.