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1.  Lifestyle Physical Activity Behavior of Korean American Dry Cleaner Couples 
Objective
The purposes of this study were to: (1) describe and compare lifestyle physical activity (leisure-time, household, and occupational physical activity), using both self-report and an objective measure of step counts, in self-employed Korean American married couples working together at dry cleaners, and (2) examine the relationship between self-report and objective measures of physical activity.
Design and Sample
Seventy couples participated in this cross-sectional, descriptive, face-to-face interview survey.
Measures
Two self-reports (28-item Community Healthy Activities Model Program for Seniors Physical Activity Questionnaire and Tecumseh Occupational Physical Activity Questionnaire) and one objective measure (New Lifestyles-800 pedometer) were used.
Results
The husbands spent significantly more time than their wives in moderate- to vigorous-intensity leisure-time physical activity (207 vs. 122 minutes/week) and occupational physical activity (2,585 vs. 1,065 minutes/week). Most couples (91%) met recommended levels of physical activity based on their occupational physical activity. Pedometer steps correlated significantly only with leisure-time physical activity.
Conclusions
Study findings suggest that to increase physical activity in Korean American couples who work in a small business, moderate-intensity lifestyle physical activity interventions across leisure-time, household, and occupational physical activity will be more successful than traditional leisure-time interventions. In addition, results suggest that there is a need for interventions that target both members of the married couple.
doi:10.1111/j.1525-1446.2011.00952.x
PMCID: PMC3732208  PMID: 22092460
physical activity; pedometer; Korean American couples
3.  Feasibility of Using Global Positioning Systems (GPS) with Diverse Urban Adults: Before and After Data on Perceived Acceptability, Barriers, and Ease of Use 
Background
Global positioning systems (GPS) have emerged as a research tool to better understand environmental influences on physical activity. This study examined the feasibility of using GPS in terms of perceived acceptability, barriers, and ease of use in a racially/ethnically diverse sample of lower socioeconomic position (SEP).
Methods
Data were from two pilot studies involving a total of 170 African American, Hispanic, and White urban adults with a mean (standard deviation) age of 47.8 (±13.1) years. Participants wore a GPS for up to seven days. They answered questions about GPS acceptability, barriers (wear-related concerns), and ease of use, before and after wearing the GPS.
Results
We found high ratings of GPS acceptability and ease of use and low levels of wear-related concerns, which were maintained after data collection. While most were comfortable with their movements being tracked, older participants (p<0.05) and African Americans (p<0.05) reported lower comfort levels. Participants who were younger, with higher education, and low incomes were more likely to indicate that the GPS made the study more interesting (p<0.05). Participants described technical and wear-related problems, but few concerns related to safety, loss, or appearance.
Conclusions
Use of GPS was feasible in this racially/ethnically diverse, lower SEP sample.
PMCID: PMC3397153  PMID: 21952361
Global positioning system; Environment; Physical activity; Feasibility; Perceptions
4.  Role of technology in Supporting Quality Control and Treatment Fidelity in a Family Caregiver Clinical Trial 
This article describes how a family caregiver lifestyle physical activity clinical trial uses research technology to enhance quality control and treatment fidelity. This trial uses a range of Internet, Blaise® Windows-based software, and Echo Server technologies to support quality control issues such as data collection, data entry and study management advocated by the clinical trials' literature, and to assure treatment fidelity concerning intervention implementation (i.e., design, training, delivery, receipt and enactment) as proposed by the National Institutes of Health Behavior Change Consortium. All research staff are trained to use these technologies. Strengths of this technological approach to support quality control and treatment fidelity include the comprehensive plan, involvement of all staff, and ability to maintain accurate and timely data. Limitations include the up-front time and costs for developing and testing these technological methods, and having support staff readily available to address technological issues if they occur.
doi:10.1177/0193945910394453
PMCID: PMC3623970  PMID: 21245285
family caregivers; physical activity intervention; quality control; treatment fidelity
5.  Multiple Instrument Translation for Use with South Asian Indian Immigrants 
Research in nursing & health  2011;34(5):419-432.
The purpose of this study was to describe translation of five measures (physical activity, acculturation, discrimination, self-efficacy, and depression) from English into Hindi using the committee translation method, focus group, and think-aloud interviews. Two South Asian Indian (SAI) immigrant bilingual translators and a moderator reached consensus on 93 of 102 items, using the committee method. Discrepancy in nine items was resolved with a focus group conducted with five bilingual SAI immigrants. Ten other bilingual SAI immigrants participated in think-aloud interviews to assess understanding and interpretation of the questions. More than 10 additional changes were made following the think-aloud interviews. Sequential use of multiple translation techniques improved translation with culturally acceptable language, thereby maintaining equivalence with original versions.
doi:10.1002/nur.20450
PMCID: PMC3171609  PMID: 21818758
Physical activity; South Asian Indians; translation; think-alouds; cross-cultural research; cognitive interviewing
6.  Activity Space Environment and Dietary and Physical Activity Behaviors: A Pilot Study 
Health & place  2011;17(5):1150-1161.
This study examined relationships among individual demographics, environmental features (e.g., fast food outlet density, park land use) of residential neighborhoods and activity spaces, and obesity-related behaviors (diet, physical activity). Participants’ movement was tracked for seven days using global positioning systems (GPS). Two activity space measures (one standard deviation ellipse, daily path area) were derived from the GPS data. Activity spaces were generally larger than residential neighborhoods; environmental features of residential neighborhoods and activity spaces were weakly associated; and some activity space environmental features were related to dietary behaviors. Activity spaces may provide new insights into environmental influences on obesity-related behaviors.
doi:10.1016/j.healthplace.2011.05.001
PMCID: PMC3224849  PMID: 21696995
Global positioning system; Activity space; Neighborhood; Diet; Physical activity; Environment
7.  Women’s Walking Program for African American women: Expectations and recommendations from participants as experts 
Women & health  2011;51(6):566-582.
Effective interventions that increase adherence to physical activity (PA) are important for African American (AA) women because generally they are less active and more obese compared to white American women. The purpose of this study was to elicit from women who began a 12-month PA program between 2002 and 2005: 1) their recollections of outcome expectations and barriers, 2) feedback on program components, and 3) suggestions for program change. In 2007, we conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three AA women aged 44–69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked < 50% of expected walks) versus high (walked ≥50% of expected walks) adherence and low (0–2) versus high (3–4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed and coded independently and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components included a lifestyle PA prescription, pedometers for self-monitoring, ongoing group support and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.
doi:10.1080/03630242.2011.606357
PMCID: PMC3293370  PMID: 21973111
African American; Physical Activity; Qualitative Methods
8.  Symptom Cluster Experience Profiles in Adult Survivors of Childhood Cancers 
Although aggressive medical treatment protocols have led to 80% 5-year survival rates for most childhood cancers, many long-term survivors experience multiple troubling symptoms. Using data from 100 adult survivors of childhood cancers (ACC-survivors), we used latent variable mixture modeling to generate unique subgroups of survivors based on their experiences with a cluster of eight symptoms: lack of energy, worry, pain, difficulty sleeping, feeling irritable, feeling nervous, difficulty concentrating, and feeling sad (as measured by the Memorial Symptom Assessment Scale). We also examined factors that were likely to predict subgroup membership (chronic health conditions, health-promoting lifestyle, and demographic variables) and determined the extent to which satisfaction with quality of life (QoL) varied across the subgroups. The final mixture model included three subgroups of ACC-survivors: high symptoms (HS) (n=21), moderate symptoms (MS) (n=45), and low symptoms (LS) (n=34). ACC-survivors who reported at least one chronic health condition were six times as likely to be classified in the HS subgroup as compared to the LS subgroup. Mean health-promoting lifestyle scores were lowest in the HS subgroup and highest in the LS subgroup. Differences in QoL among the subgroups were statistically significant, thus validating that the subgroups were characterized uniquely for identifying those symptoms with highest life impact. To our knowledge, we are the first to identify distinct subgroups of ACC-survivors differentiated by symptom cluster experience profiles. The findings warrant additional research to confirm the subgroup-specific symptom cluster experience profiles in larger studies of ACC-survivors.
doi:10.1016/j.jpainsymman.2008.09.010
PMCID: PMC2782846  PMID: 19535218
Cancer; oncology; adult survivors of childhood cancers; symptom cluster; latent variable mixture models; quality of life
9.  Neighborhood Characteristics, Adherence to Walking, and Depressive Symptoms in Midlife African American Women 
Journal of Women's Health  2009;18(8):1201-1210.
Abstract
Background
African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women.
Methods
Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included.
Results
Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks.
Conclusions
Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.
doi:10.1089/jwh.2008.1168
PMCID: PMC2825683  PMID: 19630546
10.  Neighborhood Environment and Adherence to a Walking Intervention in African-American Women 
This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban midlife African-American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women’s neighborhoods included: walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. We found presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and the other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African-American women who want to be more active.
doi:10.1177/1090198108321249
PMCID: PMC2726823  PMID: 18669878
African Americans; Neighborhood; Walking
11.  Lifestyle Physical Activity of Older Rural Women 
Research in nursing & health  2008;31(5):501-513.
The purpose of this study was to describe and examine the lifestyle physical activity behaviors (household, leisure, occupational) of older rural women. Background characteristics included demographics, environment, social support, and health. Intrapersonal characteristics included motivation and self-efficacy. The majority of the women’s energy expenditure was from the household dimension. Social support was positively associated with household activities. A higher level of leisure physical activity was associated with living within the two small cities and reporting lower levels of health and lower motivation. This research highlights the importance of household physical activity and the contribution of social support for household physical activity, both of which may be important in developing interventions to promote physical activity in older rural women.
doi:10.1002/nur.20282
PMCID: PMC2574920  PMID: 18384050
physical activity; women; rural

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