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author:("rovnak, Liza")
1.  Characterizing customers at medical center farmers’ markets1 
Journal of community health  2014;39(4):727-731.
Approximately 100 farmers’ markets operate on medical center campuses. Although these venues can uniquely serve community health needs, little is known about customer characteristics and outreach efforts. Intercept survey of markets and market customers between August 2010-October 2011 at three medical centers in different geographic regions of the US: Duke University Medical Center, Cleveland Clinic, and Penn State Hershey Medical Center were conducted. Markets reported serving 180–2000 customers per week and conducting preventive medicine education sessions and community health programs. Customers (n=585) across markets were similar in sociodemographic characteristics – most were middle-aged, white, and female, who were employees of their respective medical center. Health behaviors of customers were similar to national data. The surveyed medical center farmers’ markets currently serve mostly employees; however, markets have significant potential for community outreach efforts in preventive medicine. If farmers’ markets can broaden their reach to more diverse populations, they may play an important role in contributing to community health.
PMCID: PMC4074446  PMID: 24421001
Farmers’ Markets; Medical Center Campuses; Market customers; Community Outreach
2.  Feasibility of using a compact elliptical device to increase energy expenditure during sedentary activities 
This study aimed to evaluate the feasibility of using a compact elliptical device to increase energy expenditure during sedentary activities. A secondary aim was to evaluate if two accelerometers attached to the elliptical device could provide reliable and valid assessments of participants’ frequency and duration of elliptical device use.
Physically inactive adults (n = 32, age range = 25–65) were recruited through local advertisements and selected using stratified random sampling based on sex, body mass index (BMI), and age.
Indirect calorimetry was used to assess participants’ energy expenditure while seated and while using the elliptical device at a self-selected intensity level. Participants also self-reported their interest in using the elliptical device during sedentary activities. Two Actigraph GT3X accelerometers were attached to the elliptical device to record time-use patterns.
Participants expended a median of 179.1 kilocalories per hour while using the elliptical device (range = 108.2–269.0), or a median of 87.9 more kilocalories (range = 19.7–178.6) than they would expend per hour of sedentary sitting. Participants reported high interest in using the elliptical device during TV watching and computer work, but relatively low interest in using the device during office meetings. Women reported greater interest in using the elliptical device than men. The two accelerometers recorded identical time-use patterns on the elliptical device and demonstrated concurrent validity with time-stamped computer records.
Compact elliptical devices could increase energy expenditure during sedentary activities, and may provide proximal environmental cues for increasing energy expenditure across multiple life domains.
PMCID: PMC3926902  PMID: 24035273
Physical activity; Exercise; Sedentary lifestyle; Obesity; Environment design; Environment and public health
3.  A Strength Training Program for Primary Care Patients, Central Pennsylvania, 2012 
Primary care providers can recommend strength training programs to use “Exercise as Medicine,” yet few studies have examined the interest of primary care patients in these programs.
We conducted a cross-sectional survey of primary care patients in central Pennsylvania. Interest in participating in free group-based strength training and weight control programs was assessed, in addition to patient demographics, medical history, and quality of life.
Among 414 patients, most (61.0%) were aged 54 or older, and 64.0% were female. More patients were interested in a strength training program (55.3%) than in a weight control program (45.4%). Nearly three-quarters (72.8%) of those reporting 10 or more days of poor physical health were interested in a strength training program compared with 49.5% of those reporting no days of poor physical health. After adjusting for potential confounders, those reporting poorer physical health had 2.7 greater odds (95% confidence interval, 1.4–5.1) of being interested in a strength training program compared with those reporting better physical health. Patients with hypertension, diabetes, or high cholesterol were not more interested in a strength training program than those without these conditions.
Primary care practices may consider offering or referring patients to community-based strength training programs. This study observed high levels of interest in these widely available programs. Practices may also consider screening and referring those with poorer physical health, as they may be the most interested and have the most to gain from participating.
PMCID: PMC4075490  PMID: 24967829
4.  Dangers and opportunities for social media in medicine 
Clinical obstetrics and gynecology  2013;56(3):10.1097/GRF.0b013e318297dc38.
Health professionals have begun using social media to benefit patients, enhance professional networks, and advance understanding of individual and contextual factors influencing public health. However, discussion of the dangers of these technologies in medicine has overwhelmed consideration of positive applications. This article summarizes the hazards of social media in medicine and explores how changes in functionality on sites like Facebook may make these technologies less perilous for health professionals. Finally, it describes the most promising avenues through which professionals can use social media in medicine – improving patient communication, enhancing professional development, and contributing to public health research and service.
PMCID: PMC3863578  PMID: 23903375
social media; technology; professionalism; patient-physician relationships; communication; public health
5.  Engineering online and in-person social networks to sustain physical activity: application of a conceptual model 
BMC Public Health  2013;13:753.
High rates of physical inactivity compromise the health status of populations globally. Social networks have been shown to influence physical activity (PA), but little is known about how best to engineer social networks to sustain PA. To improve procedures for building networks that shape PA as a normative behavior, there is a need for more specific hypotheses about how social variables influence PA. There is also a need to integrate concepts from network science with ecological concepts that often guide the design of in-person and electronically-mediated interventions. Therefore, this paper: (1) proposes a conceptual model that integrates principles from network science and ecology across in-person and electronically-mediated intervention modes; and (2) illustrates the application of this model to the design and evaluation of a social network intervention for PA.
A conceptual model for engineering social networks was developed based on a scoping literature review of modifiable social influences on PA. The model guided the design of a cluster randomized controlled trial in which 308 sedentary adults were randomly assigned to three groups: WalkLink+: prompted and provided feedback on participants’ online and in-person social-network interactions to expand networks for PA, plus provided evidence-based online walking program and weekly walking tips; WalkLink: evidence-based online walking program and weekly tips only; Minimal Treatment Control: weekly tips only. The effects of these treatment conditions were assessed at baseline, post-program, and 6-month follow-up. The primary outcome was accelerometer-measured PA. Secondary outcomes included objectively-measured aerobic fitness, body mass index, waist circumference, blood pressure, and neighborhood walkability; and self-reported measures of the physical environment, social network environment, and social network interactions. The differential effects of the three treatment conditions on primary and secondary outcomes will be analyzed using general linear modeling (GLM), or generalized linear modeling if the assumptions for GLM cannot be met.
Results will contribute to greater understanding of how to conceptualize and implement social networks to support long-term PA. Establishing social networks for PA across multiple life settings could contribute to cultural norms that sustain active living.
Trial registration NCT01142804
PMCID: PMC3844372  PMID: 23945138
Social networks; Social environment; Social support; Built environment; Walking; Exercise; Accelerometers; Social media; Internet; Sustainability
6.  Medical Center Farmers Markets: A Strategic Partner in the Patient-Centered Medical Home 
The number of medical center–based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home.
Community Context
In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution’s commitment to the medical home.
We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market’s Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance’s report on the medical home.
During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695) and speaking to customers (n = 636) about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance.
Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care.
PMCID: PMC3733477  PMID: 23906327
7.  Fidelity issues in secondhand smoking interventions for children 
This paper reviews methodological and theoretical fidelity of secondhand smoking (SHS) intervention studies (n=29) that target protection of children in their home. In 2005, interventions were evaluated in terms of treatment fidelity according to guidelines provided by Borrelli et al. of the National Institutes of Health Behavior Change Consortium. The degree of fidelity was evaluated based on the percentage of criteria met; the inter-rater reliability based on percent agreement across independent raters was 0.78. Analysis indicated that studies with higher treatment fidelity were more likely to obtain statistically significant results (p=.003) with the average fidelity rating of 0.74 for statistically significant studies vs. 0.50 for statistically non-significant studies. Higher treatment fidelity was also significantly associated with being a more recent investigation (year 2000 or later), an efficacy as compared to effectiveness trial, more intensive as compared to less intensive intervention, a trial in the U.S. as compared to foreign nations, and having a theoretical basis. After taking all other variables into account, only treatment fidelity was significantly related to study outcome (p=.052). Ratings of treatment fidelity were ranked and compared to previous rankings based on 342 behavioral change interventions; the rank-ordered correlation between previous and current ratings was 0.84, although median fidelity ratings were 0.10 points lower in the previous than in the present study (0.52 vs. 0.62; intraclass correlation=0.79). Improvements to the treatment fidelity evaluation guidelines were suggested, including the consideration of theoretical fidelity. Enhancing methodological and theoretical fidelity will speed identification of valid theoretical precepts that will, in turn, guide effective public health prevention programs.
PMCID: PMC3533496  PMID: 19023822
8.  Adults' Physical Activity Patterns across Life Domains: Cluster Analysis with Replication 
Identifying adults' physical activity patterns across multiple life domains could inform the design of interventions and policies.
Cluster analysis was conducted with adults in two US regions (Baltimore-Washington DC, n = 702; Seattle-King County, n = 987) to identify different physical activity patterns based on adults' reported physical activity across four life domains: leisure, occupation, transport, and home. Objectively measured physical activity, and psychosocial and built (physical) environment characteristics of activity patterns were examined.
Main Outcome Measures
Accelerometer-measured activity, reported domain-specific activity, psychosocial characteristics, built environment, body mass index (BMI).
Three clusters replicated (kappa = .90-.93) across both regions: Low Activity, Active Leisure, and Active Job. The Low Activity and Active Leisure adults were demographically similar, but Active Leisure adults had the highest psychosocial and built environment support for activity, highest accelerometer-measured activity, and lowest BMI. Compared to the other clusters, the Active Job cluster had lower socioeconomic status and intermediate accelerometer-measured activity.
Adults can be clustered into groups based on their patterns of accumulating physical activity across life domains. Differences in psychosocial and built environment support between the identified clusters suggest that tailored interventions for different subgroups may be beneficial.
PMCID: PMC3021982  PMID: 20836604
cluster analysis; exercise; built environment; social environment; accelerometer
9.  Engaging Community Businesses in HIV Prevention: A Feasibility Study 
To explore the feasibility of engaging community businesses in HIV prevention.
Randomly selected business owners/managers were asked to display discreetly wrapped condoms and brochures provided free-of-charge for 3 months. Assessments were conducted at baseline, mid-, and post-program. Customer feedback was obtained through an online survey.
San Diego, California neighborhood with a high rate of AIDS.
Fifty-one business owners/managers representing 10 retail categories, and 52 customers.
Participation rates, descriptive characteristics, number of condoms and brochures distributed, customer feedback, business owners'/managers' program satisfaction and willingness to provide future support for HIV prevention.
Kruskal-Wallis, Mann-Whitney U, Fisher's exact, and McNemar's tests were used to analyze data.
The 20 business owners/managers (39%) who agreed to distribute condoms and brochures reported fewer years in business and more employees than those who agreed only to distribute brochures (20%) or refused to participate (41%), p <.05. Bars were the easiest of ten retail categories to recruit. Businesses with more employees and customers distributed more condoms and brochures, p < .05. More than 90% of customers supported distributing condoms and brochures in businesses and 96% of business owners/managers described their program experience as “positive.”
Businesses are willing to distribute condoms and brochures to prevent HIV. Policies to increase business participation in HIV prevention should be developed and tested.
PMCID: PMC2871324  PMID: 20465150
Condoms; commerce; social marketing; social environment; environment design; environmental policy
10.  Colorectal Cancer Test Use among Californians of Mexican Origin: Influence of Language Barriers 
Ethnicity & disease  2009;19(3):315-322.
Striking decreases in colorectal cancer (CRC) incidence have been seen recently in non-Latino Whites but not in Latinos. The purpose of our study was to examine the influence of limited English proficiency (LEP) on differences in CRC test use rates between Mexican American and non-Latino White adults in California and reported reasons for not getting a CRC exam.
Cross-sectional analysis of the 2005 California Health Interview Survey (CHIS).
Representative sample of non-institutionalized adults living in California.
Mexican American (n=1,529) and non-Latino White men and women aged 50 and older (n=16,775) who had not been diagnosed with CRC.
Logistic regression analyzed the effect of ethnicity and limited English proficiency (LEP) on CRC test use after adjusting for sociodemographics, healthcare access, health status, and other health behaviors.
Main Outcome Measures
Respondents' likelihood of not receiving the CRC exam was examined as a function of ethnicity and LEP status; differences in reasons for not receiving CRC testing between ethnic groups were also examined.
More than 40% of Californian Mexican American adults aged 50 and older have never had either fecal occult blood test or lower endoscopy CRC tests. Mexican Americans were more likely to have difficulty understanding their doctor due to language barriers (P<.01). Mexican Americans more often reported provider barriers in getting an endoscopy (ie, test was not recommended by their medical provider) than non-Latino Whites (P=.01). After adjustment for covariates, Mexican Americans were 1.32 times and those with LEP were 1.68 times more likely to have never had either CRC test.
Limited English proficiency significantly decreased the likelihood of getting tested for CRC (P<.01). Eliminating language barriers should result in improvements in CRC test use among limited English proficiency Mexican Americans.
PMCID: PMC2757758  PMID: 19769015
Mexican Americans; Colonoscopy; Colorectal Cancer; Screening
11.  Reducing the Gap Between the Economic Costs of Tobacco and Funds for Tobacco Training in Schools of Public Health 
Public Health Reports  2006;121(5):538-546.
Tobacco use costs approximately $167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.
PMCID: PMC1564463  PMID: 16972507

Results 1-11 (11)