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1.  A Tale of Two Teachers: A Preschool Physical Activity Intervention Case Study 
The Journal of school health  2016;86(1):23-30.
BACKGROUND
Preschool settings vary greatly, and research has shown that interventions are more successful when they can be adapted to individual settings. This is a descriptive case study of how two teachers successfully adapted and implemented a preschool physical activity intervention.
METHODS
The Study of Health and Activity in Preschool Environments (SHAPES) was a three-year physical activity intervention. A detailed case study of two high-implementing teachers was conducted. Multiple data sources included accelerometry, direct observation, teacher surveys and intervention staff field notes.
RESULTS
Teacher A focused on integrating physical activity into a wide range of activities, including parent and community events. Teacher B focused on high-intensity, structured activities. Both teachers supported the intervention, worked closely with intervention staff, and operated their classroom as an autonomous unit with support from their directors. Teacher A provided an average of 31.5, 78.0 and 67.5 minutes of physical activity opportunity per day of observation during Years 1, 2, and 3. Teacher B provided an average of 2.7, 33.5, and 73.3 minutes of physical activity opportunity per day of observation.
CONCLUSION
Successful implementation of physical activity interventions may look different in different contexts; thus, interventions should allow for flexible implementation.
doi:10.1111/josh.12352
PMCID: PMC5069971  PMID: 26645417
children; physical activity; intervention; preschool
2.  Making healthy eating and physical activity policy practice: process evaluation of a group randomized controlled intervention in afterschool programs 
Health Education Research  2015;30(6):849-865.
This study describes the link between level of implementation and outcomes from an intervention to increase afterschool programs’ (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying factors essential to meeting HE-PA Standards, while 10 control ASPs continued routine practice. All programs, intervention and control, were assigned a STEPs for HE-PA index score based on implementation. Mixed-effects linear regressions showed high implementation ASPs had the greatest percentage of boys and girls achieving 30 min of moderate-to-vigorous physical activity (47.3 and 29.3%), followed by low implementation ASPs (41.3 and 25.0%), and control ASPs (34.8 and 18.5%). For healthy eating, high/low implementation programs served fruits and vegetables an equivalent number of days, but more days than control programs (74.0 and 79.1% of days versus 14.2%). A similar pattern emerged for the percent of days sugar-sweetened foods and beverages were served, with high and low implementation programs serving sugar-sweetened foods (8.0 and 8.4% of days versus 52.2%), and beverages (8.7 and 2.9% of days versus 34.7%) equivalently, but less often than control programs. Differences in characteristics and implementation of STEPs for HE-PA between high/low implementers were also identified.
doi:10.1093/her/cyv052
PMCID: PMC4836399  PMID: 26590240
3.  Clarifying Definitions for the Massage Therapy Profession: the Results of the Best Practices Symposium† 
Background
Massage therapists are at times unclear about the definition of massage therapy, which creates challenges for the profession. It is important to investigate the current definitions and to consider the field as a whole in order to move toward clarity on what constitutes the constructs within the profession.
Purpose
To determine how a sample of experts understand and describe the field of massage therapy as a step toward clarifying definitions for massage and massage therapy, and framing the process of massage therapy practice.
Setting
A two-day symposium held in 2010 with the purpose of gathering knowledge to inform and aid in the creation of massage therapy best practice guidelines for stress and low back pain.
Participants
Thirty-two experts in the field of massage therapy from the United States, Europe, and Canada.
Design
Qualitative analysis of secondary cross-sectional data using a grounded theory approach.
Results
Three over-arching themes were identified: 1) What is massage?; 2) The multidimensional nature of massage therapy; and 3) The influencing factors on massage therapy practice.
Discussion
The data offered clarifying definitions for massage and massage therapy, as well as a framework for the context for massage therapy practice. These clarifications can serve as initial steps toward the ultimate goal of creating new theory for the field of massage therapy, which can then be applied in practice, education, research, and policy.
Conclusions
Foundational research into how experts in the profession understand and describe the field of massage therapy is limited. Understanding the potential differences between the terms massage and massage therapy could contribute to a transformation in the profession in the areas of education, practice, research, policy and/or regulation. Additionally, framing the context for massage therapy practice invites future discussions to further clarify practice issues.
PMCID: PMC5017817  PMID: 27648109
massage therapy; clinical practice; qualitative research; grounded theory; ecological framework; context
4.  Motivation and Behavioral Regulation of Physical Activity in Middle-School Students 
Purpose
To examine whether intrinsic motivation and behavioral self-regulation are related to physical activity during middle school.
Method
Structural equation modeling was applied in cross-sectional and longitudinal tests of self-determination theory.
Results
Consistent with theory, hypothesized relationships among variables were supported. Integrated regulation and intrinsic motivation were most strongly correlated with moderate-to-vigorous physical activity measured by an accelerometer. Results were independent of a measure of biological maturity. Construct validity and equivalence of measures was confirmed longitudinally between 6th and 7th grades and between boys and girls, non-Hispanic black and white children and overweight and normal weight students.
Conclusions
Measures of autonomous motivation (identified, integrated, and intrinsic) were more strongly related to physical activity in the 7th grade than measures of controlled motivation (external and introjected), implying that physical activity became more intrinsically motivating for some girls and boys as they moved through middle school. Nonetheless, introjected regulation was related to physical activity in 7th grade, suggesting that internalized social pressures, which can be detrimental to sustained activity and well-being, also became motivating. These results encourage longer prospective studies during childhood and adolescence to clarify how controlled and autonomous motivations for physical activity develop and whether they respond to interventions designed to increase physical activity.
doi:10.1249/MSS.0000000000000616
PMCID: PMC4515416  PMID: 25628178
accelerometer; construct validity; multi-ethnic; overweight; self-determination; self-schema
5.  Airway smooth muscle NOX4 is upregulated and modulates ROS generation in COPD 
Respiratory Research  2016;17:84.
The burden of oxidative stress is increased in chronic obstructive pulmonary disease (COPD). However, whether the intra-cellular mechanisms controlling the oxidant/anti-oxidant balance in structural airway cells such as airway smooth muscle in COPD is altered is unclear. We sought to determine whether the expression of the NADPH oxidase (NOX)-4 is increased in airway smooth muscle in COPD both in vivo and primary cells in vitro and its role in hydrogen peroxide-induced reactive oxygen species generation. We found that in vivo NOX4 expression was up-regulated in the airway smooth muscle bundle in COPD (n = 9) and healthy controls with >20 pack year history (n = 4) compared to control subjects without a significant smoking history (n = 6). In vitro NOX4 expression was increased in airway smooth muscle cells from subjects with COPD (n = 5) compared to asthma (n = 7) and upregulated following TNF-α stimulation. Hydrogen peroxide-induced reactive oxygen species generation by airway smooth muscle cells in COPD (n = 5) was comparable to healthy controls (n = 9) but lower than asthma (n = 5); and was markedly attenuated by NOX4 inhibition. Our findings demonstrate that NOX4 expression is increased in vivo and in vitro in COPD and although we did not observe an intrinsic increase in oxidant-induced reactive oxygen species generation in COPD, it was reduced markedly by NOX4 inhibition supporting a potential therapeutic role for NOX4 in COPD.
doi:10.1186/s12931-016-0403-y
PMCID: PMC4950777  PMID: 27435477
COPD; Oxidative stress; Reactive oxygen species; Airway smooth muscle; NOX4
6.  NADPH Oxidase-4 Overexpression Is Associated With Epithelial Ciliary Dysfunction in Neutrophilic Asthma 
Chest  2016;149(6):1445-1459.
Background
Bronchial epithelial ciliary dysfunction is an important feature of asthma. We sought to determine the role in asthma of neutrophilic inflammation and nicotinamide adenine dinucleotide phosphate (NADPH) oxidases in ciliary dysfunction.
Methods
Bronchial epithelial ciliary function was assessed by using video microscopy in fresh ex vivo epithelial strips from patients with asthma stratified according to their sputum cell differentials and in culture specimens from healthy control subjects and patients with asthma. Bronchial epithelial oxidative damage was determined by 8-oxo-dG expression. Nicotinamide adenine dinucleotide phosphate oxidase (NOX)/dual oxidase (DUOX) expression was assessed in bronchial epithelial cells by using microarrays, with NOX4 and DUOX1/2 expression assessed in bronchial biopsy specimens. Ciliary dysfunction following NADPH oxidase inhibition, using GKT137831, was evaluated in fresh epithelial strips from patients with asthma and a murine model of ovalbumin sensitization and challenge.
Results
Ciliary beat frequency was impaired in patients with asthma with sputum neutrophilia (n = 11) vs those without (n = 10) (5.8 [0.6] Hz vs 8.8 [0.5] Hz; P = .003) and was correlated with sputum neutrophil count (r = –0.70; P < .001). Primary bronchial epithelial cells expressed DUOX1/2 and NOX4. Levels of 8-oxo-dG and NOX4 were elevated in patients with neutrophilic vs nonneutrophilic asthma, DUOX1 was elevated in both, and DUOX2 was elevated in nonneutrophilic asthma in vivo. In primary epithelial cultures, ciliary dysfunction did not persist, although NOX4 expression and reactive oxygen species generation was increased from patients with neutrophilic asthma. GKT137831 both improved ciliary function in ex vivo epithelial strips (n = 13), relative to the intensity of neutrophilic inflammation, and abolished ciliary dysfunction in the murine asthma model with no reduction in inflammation.
Conclusions
Ciliary dysfunction is increased in neutrophilic asthma associated with increased NOX4 expression and is attenuated by NADPH oxidase inhibition.
doi:10.1016/j.chest.2016.01.024
PMCID: PMC4893823  PMID: 26836936
asthma; epithelial cells; NOX4; oxidative stress; ALI, air-liquid interface; CBF, ciliary beat frequency; DUOX, dual oxidase part of the NOX/DUOX family; GINA, Global Initiative for Asthma; mRNA, messenger RNA; NADPH, nicotinamide adenine dinucleotide phosphate; NOX, nicotinamide adenine dinucleotide phosphate oxidase part of the NOX/DUOX family; OVA, ovalbumin; ROS, reactive oxygen species
7.  Associations between home environment and after-school physical activity and sedentary time among 6th grade children 
Pediatric exercise science  2014;27(2):226-233.
This study examined associations of various elements of the home environment with after-school physical activity and sedentary time in 671 sixth-grade children (Mage = 11.49 ± 0.5 years). Children’s after-school total physical activity (TPA), moderate-to-vigorous physical activity (MVPA) and sedentary time were measured by accelerometry. Parents completed surveys assessing elements of the home social and physical environment. Mixed-model regression analyses were used to examine the associations between each element of the home environment and children’s after-school physical activity and sedentary time. Availability of home physical activity resources was associated positively with after-school TPA and negatively with after-school sedentary time in boys. Parental support was associated positively with after-school TPA and MVPA and negatively with after-school sedentary time in girls. The home physical environment was associated with boys’ after-school physical activity and sedentary time, whereas the home social environment was associated with girls’ after-school physical activity and sedentary time.
doi:10.1123/pes.2014-0061
PMCID: PMC4426238  PMID: 25386734
activity-related parenting; availability of physical activity resources; parental support
8.  NADPH Oxidase-4 Overexpression Is Associated With Epithelial Ciliary Dysfunction in Neutrophilic Asthma 
Chest  2016;149(6):1445-1459.
Background
Bronchial epithelial ciliary dysfunction is an important feature of asthma. We sought to determine the role in asthma of neutrophilic inflammation and nicotinamide adenine dinucleotide phosphate (NADPH) oxidases in ciliary dysfunction.
Methods
Bronchial epithelial ciliary function was assessed by using video microscopy in fresh ex vivo epithelial strips from patients with asthma stratified according to their sputum cell differentials and in culture specimens from healthy control subjects and patients with asthma. Bronchial epithelial oxidative damage was determined by 8-oxo-dG expression. Nicotinamide adenine dinucleotide phosphate oxidase (NOX)/dual oxidase (DUOX) expression was assessed in bronchial epithelial cells by using microarrays, with NOX4 and DUOX1/2 expression assessed in bronchial biopsy specimens. Ciliary dysfunction following NADPH oxidase inhibition, using GKT137831, was evaluated in fresh epithelial strips from patients with asthma and a murine model of ovalbumin sensitization and challenge.
Results
Ciliary beat frequency was impaired in patients with asthma with sputum neutrophilia (n = 11) vs those without (n = 10) (5.8 [0.6] Hz vs 8.8 [0.5] Hz; P = .003) and was correlated with sputum neutrophil count (r = –0.70; P < .001). Primary bronchial epithelial cells expressed DUOX1/2 and NOX4. Levels of 8-oxo-dG and NOX4 were elevated in patients with neutrophilic vs nonneutrophilic asthma, DUOX1 was elevated in both, and DUOX2 was elevated in nonneutrophilic asthma in vivo. In primary epithelial cultures, ciliary dysfunction did not persist, although NOX4 expression and reactive oxygen species generation was increased from patients with neutrophilic asthma. GKT137831 both improved ciliary function in ex vivo epithelial strips (n = 13), relative to the intensity of neutrophilic inflammation, and abolished ciliary dysfunction in the murine asthma model with no reduction in inflammation.
Conclusions
Ciliary dysfunction is increased in neutrophilic asthma associated with increased NOX4 expression and is attenuated by NADPH oxidase inhibition.
doi:10.1016/j.chest.2016.01.024
PMCID: PMC4893823  PMID: 26836936
asthma; epithelial cells; NOX4; oxidative stress; ALI, air-liquid interface; CBF, ciliary beat frequency; DUOX, dual oxidase part of the NOX/DUOX family; GINA, Global Initiative for Asthma; mRNA, messenger RNA; NADPH, nicotinamide adenine dinucleotide phosphate; NOX, nicotinamide adenine dinucleotide phosphate oxidase part of the NOX/DUOX family; OVA, ovalbumin; ROS, reactive oxygen species
9.  Process Evaluation of an Intervention to Increase Child Activity Levels in Afterschool Programs 
Background
Identifying effective strategies in Afterschool programs (ASPs) to increase children's moderate-to-vigorous physical activity (MVPA) in the ASP setting is crucial. This study describes the process evaluation outcomes from an intervention to reduce child sedentary time and increase MVPA in ASPs.
Methods
Four ASPs participated in a quasi-experimental single-group pre-post study targeting child sedentary time and MVPA. The strategies implemented to help ASPs meet Physical Activity Standards consisted of detailed schedules, professional development trainings, on-site booster sessions, and technical assistance. Process evaluation related to staff behaviors was collected via systematic observation to identify the interventions impact on the physical and social environment of the ASP. Random-effects regression models examined the impact of the intervention on boys/girls observed sedentary behavior, MVPA, and changes in staff behaviors.
Results
Increases in MVPA and reductions in sedentary behavior were observed during enrichment, academics, organized and free-play physical activities (PA). Corresponding changes in staff behaviors were observed during these ASP contexts. For example, staff reduced child idle-time during organized PA (38.9%-1.8%) and provided energizers more often during enrichment (0.2%-11.5%).
Conclusions
This study identified changes in staff behavior during ASP contexts that led to increases in child MVPA and decreases in child sedentary behavior.
doi:10.1016/j.evalprogplan.2014.04.004
PMCID: PMC4091803  PMID: 24836999
Community; physical activity; out-of-school-time
10.  A Comprehensive Professional Development Training's Effect on Afterschool Program Staff Behaviors to Promote Healthy Eating and Physical Activity 
Objective
Evaluate a comprehensive intervention designed to support staff and program leaders in the implementation of the YMCA of USA Healthy Eating and Physical Activity (HEPA) Standards for their afterschool programs (3-6pm).
Design
Pre (Fall 2011) and post (Spring 2012) assessment no control-group.
Setting/Participants
Four large-scale YMCA afterschool programs serving approximately 500 children.
Intervention
Professional development training founded in the 5Ms (i.e. Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (i.e. lines, elimination, team size, uninvolved staff/kids, and space, equipment and rules), on-site booster training sessions, workshops, and ongoing technical support for staff and program leaders from January to May 2012.
Main outcome measures
System for Observing Staff Promotion of Activity and Nutrition (SOSPAN).
Analysis
Multilevel mixed effects linear (i.e., staff behaviors expressed as a percentage of the number of scans observed) and logistic regression.
Results
A total of 5328 SOSPAN scans were completed over the two measurement periods. Of the 20 staff behaviors identified in HEPA Standards and measured in this study, 17 increased or decreased in the appropriate direction. For example, staff engaged in physical activity with children increased from 26.6% to 37% and staff eating unhealthy foods decreased from 42.1% to 4.5%.
Conclusions
Comprehensive professional development training, founded in the 5Ms and LET US Play principles, and ongoing technical assistance can have a sizable impact on key staff behaviors identified by HEPA Standards for afterschool programs.
doi:10.1097/PHH.0b013e3182a1fb5d
PMCID: PMC4048879  PMID: 24858323
Intervention; obesity; out-of-school-time; children
11.  Making Healthy Eating and Physical Activity Policy Practice: The Design and Overview of a Group Randomized Controlled Trial in Afterschool Programs 
Contemporary clinical trials  2014;38(2):291-303.
National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1,800 children (6-12yrs) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs’ daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children’s accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness.
doi:10.1016/j.cct.2014.05.013
PMCID: PMC4104269  PMID: 24893225
Policy; Obesity; Children; Moderate-to-Vigorous; Fruit; Community
12.  A Coordinated Comprehensive Professional Development Training’s Effect on Summer Day Camp Staff Healthy Eating and Physical Activity Promoting Behaviors 
Background
The YMCA of USA recently adopted Healthy Eating and Physical Activity (HEPA) Standards for their summer-day-camps (SDCs). Standards call for staff to exhibit HEPA promoting behaviors while eliminating HEPA discouraging behaviors. No studies have evaluated training programs to influence policy specified staff behaviors and related changes in child activity in SDCs.
Method
Four YMCA summer-day-camps serving approximately 800 children per week participated in this no control group pre/post pilot study. Professional development training founded in the 5Ms (Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (lines, elimination, team size, uninvolved staff/kids, and space, equipment and rules) was delivered to staff. Outcomes were staff promotion behaviors and child activity assessed via systematic observation instruments.
Results
Twelve of 17 HEPA staff behaviors changed in the appropriate direction from baseline to post-assessment with five behaviors reaching statistically significant changes. The percentage of girls and boys observed in moderate-to-vigorous-physical-activity increased from 15.3% to 18.3% (p > .05) and 17.9% to 21.2% whereas sedentary behavior decreased from 66.8% to 59.8% and 62.3% to 53.6%, respectively.
Conclusion
Evidence suggests that the professional development training designed to assist SDCs to meet the HEPA Standards can lead to important changes in staff behaviors and children’s physical activity.
doi:10.1123/jpah.2012-0442
PMCID: PMC4429910  PMID: 25368946
Intervention; obesity; policy; summer day camp; children
13.  Double Dose: The cumulative effect of TV viewing at home and in preschool on children’s activity patterns and weight status 
Pediatric exercise science  2013;25(2):262-272.
Little is known about how screen-based sedentary behavior at home and in preschool influences children’s health and activity patterns. The current study examined the individual and cumulative influence of TV viewing at home and in preschool on children’s physical activity (PA) and weight status. Children (n=339) attending 16 preschools in South Carolina were grouped into high and low TV groups based on parent report of children’s TV viewing at home and director report of TV use/rules in preschool. T-tests and mixed model ANOVAs examined differences in weight status and PA (min/hr) by high and low TV groups. Results revealed that children who were classified as High TV both at home and in preschool had significantly lower levels of moderate-to-vigorous PA compared with their Low TV counterparts. These findings demonstrate the importance of total environmental TV exposure on preschooler’s PA. Longitudinal and observational research to assess preschoolers’ cumulative screen-based sedentary behavior and its relationship with PA and weight status is needed.
PMCID: PMC4383279  PMID: 23502043
14.  Process evaluation methods, implementation fidelity results and relationship to physical activity and healthy eating in the Faith, Activity, and Nutrition (FAN) study 
Faith, Activity and Nutrition (FAN), a community-based participatory research project in African American churches, aimed to increase congregant physical activity and healthy eating. The Health-Promoting Church framework, developed collaboratively with faith-based partners, guided the intervention and a comprehensive process evaluation. The Health-Promoting Church components related to healthy eating and physical activity were getting the message out, opportunities, pastor support, and organizational policy. There was no evidence for sequential mediation for any of the healthy eating components. These results illustrate the complexity of systems change within organizational settings and the importance of conducting process evaluation. The FAN intervention resulted in increased implementation for all physical activity and most healthy eating components. Mediation analyses revealed no direct association between implementation and increased physical activity; rather, sequential mediation analysis showed that implementation of physical activity messages was associated with improved self-efficacy at the church level, which was associated with increased physical activity.
doi:10.1016/j.evalprogplan.2013.11.003
PMCID: PMC4022598  PMID: 24394548
Process evaluation; Implementation; Mediation analysis; Faith-based setting
15.  No evidence for altered intracellular calcium-handling in airway smooth muscle cells from human subjects with asthma 
Background
Asthma is characterized by airway hyper-responsiveness and variable airflow obstruction, in part as a consequence of hyper-contractile airway smooth muscle, which persists in primary cell culture. One potential mechanism for this hyper-contractility is abnormal intracellular Ca2+ handling.
Methods
We sought to compare intracellular Ca2+ handling in airway smooth muscle cells from subjects with asthma compared to non-asthmatic controls by measuring: i) bradykinin-stimulated changes in inositol 1,4,5-trisphosphate (IP3) accumulation and intracellular Ca2+ concentration, ii) sarco/endoplasmic reticulum Ca2+-ATPase (SERCA) expression, iii) mechanisms of cytoplasmic Ca2+ clearance assessed following instantaneous flash photolytic release of Ca2+ into the cytoplasm.
Results
We found no differences in airway smooth muscle cell basal intracellular Ca2+ concentrations, bradykinin-stimulated IP3 accumulation or intracellular Ca2+ responses. Quantification of SERCA2 mRNA or protein expression levels revealed no differences in ASM cells obtained from subjects with asthma compared to non-asthmatic controls. We did not identify differences in intracellular calcium kinetics assessed by flash photolysis and calcium uncaging independent of agonist-activation with or without SERCA inhibition. However, we did observe some correlations in subjects with asthma between lung function and the different cellular measurements of intracellular Ca2+ handling, with poorer lung function related to increased rate of recovery following flash photolytic elevation of cytoplasmic Ca2+ concentration.
Conclusions
Taken together, the experimental results reported in this study do not demonstrate major fundamental differences in Ca2+ handling between airway smooth muscle cells from non-asthmatic and asthmatic subjects. Therefore, increased contraction of airway smooth muscle cells derived from asthmatic subjects cannot be fully explained by altered Ca2+ homeostasis.
doi:10.1186/s12890-015-0009-z
PMCID: PMC4349477  PMID: 25880173
Asthma; Airway smooth muscle; Calcium; Sarco/endoplasmic reticulum Ca2+ ATPase type 2 (SERCA2); Inositol 1,4,5-trisphosphate
16.  Sedentary Behaviors in Fifth-Grade Boys and Girls: Where, with Whom, and Why? 
Childhood Obesity  2013;9(6):532-539.
Abstract
Background: An understanding of the context surrounding screen- and non-screen-based sedentary behavior would facilitate efforts to reduce children's overall sedentary behavior. This study examined the prevalence of specific types of sedentary behavior in children, the social and physical contexts surrounding these behaviors, and differences by gender.
Methods: Participants included 686 fifth graders participating in the Transitions and Activity Changes in Kids Study (TRACK). The Physical Activity Choices instrument measured child participation in seven sedentary behaviors, the social (i.e., with whom) and physical (i.e., where) contexts, and perceptions (i.e., why) of those behaviors. Analysis included mixed-model regression adjusted for race/ethnicity, BMI, and socioeconomic status.
Results: Children participated in both screen- and non-screen-based sedentary behaviors at very high frequencies. The most popular activities included watching television or videos, listening to music, playing video games (boys only), and talking on the phone or texting (girls only). Children engaged in sedentary behaviors most often at home, at school, or in their neighborhood. In general, the patterns of social context for the behaviors were similar for boys and girls, with the exception of video game playing. Girls perceived listening to music and talking on the phone or texting to be more fun than boys; children did not differ in their other perceptions (i.e., how much choice or how important) of the behaviors.
Conclusions: Multi-level interventions that target reducing sedentary behavior in the home, neighborhood, and school context may be most effective; however, the approach needed will likely differ by gender.
doi:10.1089/chi.2013.0021
PMCID: PMC3868294  PMID: 24147817
17.  Construct Validity of Selected Measures of Physical Activity Beliefs and Motives in Fifth and Sixth Grade Boys and Girls 
Journal of Pediatric Psychology  2013;38(5):563-576.
Objective Scales used to measure selected social-cognitive beliefs and motives for physical activity were tested among boys and girls. Methods Covariance modeling was applied to responses obtained from large multi-ethnic samples of students in the fifth and sixth grades. Results Theoretically and statistically sound models were developed, supporting the factorial validity of the scales in all groups. Multi-group longitudinal invariance was confirmed between boys and girls, overweight and normal weight students, and non-Hispanic black and white children. The construct validity of the scales was supported by hypothesized convergent and discriminant relationships within a measurement model that included correlations with physical activity (MET • min/day) measured by an accelerometer. Conclusions Scores from the scales provide valid assessments of selected beliefs and motives that are putative mediators of change in physical activity among boys and girls, as they begin the understudied transition from the fifth grade into middle school, when physical activity naturally declines.
doi:10.1093/jpepsy/jst013
PMCID: PMC3716273  PMID: 23459310
accelerometer; construct validity; invariance; measurement equivalence; multi-ethnic; overweight
18.  Fibrocyte localization to the airway smooth muscle is a feature of asthma 
Background
Airway smooth muscle (ASM) hyperplasia is a hallmark of asthma that is associated with disease severity and persistent airflow obstruction.
Objectives
We sought to investigate whether fibrocytes, a population of peripheral blood mesenchymal progenitors, are recruited to the ASM compartment in asthma.
Methods
We assessed the number of fibrocytes in bronchial biopsy specimens and peripheral blood from subjects with mild-to-severe refractory asthma versus healthy control subjects. In vitro we investigated potential mechanisms controlling fibrocyte migration toward the ASM bundle.
Results
Fifty-one subjects with asthma and 33 control subjects were studied. In bronchial biopsy specimens, the number of fibrocytes was increased in the lamina propria of subjects with severe refractory asthma (median [interquartile range] number, 1.9/mm2 [1.7/mm2]) versus healthy control subjects (median [interquartile range] number, 0/mm2 [0.3/mm2], P < .0001) and in the ASM bundle of subjects with asthma of all severities (subjects with severe asthma, median [interquartile range] number, 3.8/mm2 [9.4/mm2]; subjects with mild-to-moderate asthma, median [interquartile range] number, 1.1/mm2 [2.4/mm2]); healthy control subjects, (median [interquartile range] number, 0/mm2 [0/mm2]); P = .0004). In the peripheral blood the fibrocyte number was also increased in subjects with severe refractory asthma (median [interquartile range] number, 1.4 × 104/mL [2.6 × 104/mL]) versus healthy control subjects (median [interquartile range] number, 0.4 × 104/mL [1.0 × 104/mL], P = .002). We identified that in vitro ASM promotes fibrocyte chemotaxis and chemokinesis (distance of migration after 4.5 hours, 31 μm [2.9 μm] vs 17 μm [2.4 μm], P = .0001), which was in part mediated by platelet-derived growth factor (mean inhibition by neutralizing antibody, 16% [95% CI, 2% to 32%], P = .03) but not by activation of chemokine receptors.
Conclusion
This study provides the first evidence that fibrocytes are present in the ASM compartment in asthma and that ASM can augment fibrocyte migration. The importance of fibrocytes in the development of ASM hyperplasia and airway dysfunction in asthma remains to be determined.
doi:10.1016/j.jaci.2008.10.048
PMCID: PMC3992369  PMID: 19081612
Asthma; airway smooth muscle; remodeling; mast cells
19.  Eosinophil protein in airway macrophages: A novel biomarker of eosinophilic inflammation in patients with asthma 
Background
Noneosinophilic asthma is common across asthma severities. However, in patients with moderate-to-severe disease, the absence of sputum eosinophilia cannot distinguish between asthmatic subjects with eosinophilic inflammation controlled by corticosteroids versus those in whom eosinophilic inflammation is not a component of the disease.
Objectives
We sought to develop a method to quantify eosinophil proteins in airway macrophages as a novel biomarker of eosinophilic airway inflammation.
Methods
Eosinophil proteins in airway macrophages were assessed by means of flow cytometry, immunofluorescence, and cytoplasmic hue change after ingestion of apoptotic eosinophils. Airway macrophage median percentage of red-hued area in stained sputum cytospin preparations was assessed by means of image analysis from (1) subjects with mild-to-severe asthma, subjects with nonasthmatic eosinophilic bronchitis, and healthy control subjects; (2) subjects with eosinophilic severe asthma after treatment with prednisolone; and (3) subject with noneosinophilic asthma before corticosteroid withdrawal.
Results
Eosinophil proteins were detected in airway macrophages, and cytoplasmic red hue increased after ingestion of apoptotic eosinophils. Airway macrophage percentage red-hued area was increased in subjects with moderate-to-severe asthma compared with that seen in subjects with mild asthma and healthy control subjects, was similar in those with or without a sputum eosinophilia, and was increased after corticosteroid therapy. In asthmatic subjects without sputum eosinophilia, the airway macrophage percentage red-hued area was increased in subjects who did versus those who did not have sputum eosinophilia after corticosteroid withdrawal.
Conclusions
Eosinophil proteins can be reliably measured in airway macrophages. In combination with sputum eosinophilia, the macrophage eosinophil protein content might further define the asthma phenotype and provide an additional tool to direct therapy.
doi:10.1016/j.jaci.2010.03.026
PMCID: PMC3992372  PMID: 20639010
Asthma; macrophage; eosinophil; computer-assisted image analysis; induced sputum
20.  Human Airway Smooth Muscle Promotes Human Lung Mast Cell Survival, Proliferation, and Constitutive Activation: Cooperative Roles for CADM1, Stem Cell Factor, and IL-61 
The microlocalization of mast cells within specific tissue compartments is thought to be critical for the pathophysiology of many diverse diseases. This is particularly evident in asthma where they localize to the airway smooth muscle (ASM) bundles. Mast cells are recruited to the ASM by numerous chemoattractants and adhere through CADM1, but the functional consequences of this are unknown. In this study, we show that human ASM maintains human lung mast cell (HLMC) survival in vitro and induces rapid HLMC proliferation. This required cell-cell contact and occurred through a cooperative interaction between membrane-bound stem cell factor (SCF) expressed on ASM, soluble IL-6, and CADM1 expressed on HLMC. There was a physical interaction in HLMC between CADM1 and the SCF receptor (CD117), suggesting that CADM1-dependent adhesion facilitates the interaction of membrane-bound SCF with its receptor. HLMC-ASM coculture also enhanced constitutive HLMC degranulation, revealing a novel smooth muscle-driven allergen-independent mechanism of chronic mast cell activation. Targeting these interactions in asthma might offer a new strategy for the treatment of this common disease.
PMCID: PMC3992374  PMID: 18684968
21.  Mast Cells Promote Airway Smooth Muscle Cell Differentiation via Autocrine Up-Regulation of TGF-β11 
Asthma is a major cause of morbidity and mortality worldwide. It is characterized by airway dysfunction and inflammation. A key determinant of the asthma phenotype is infiltration of airway smooth muscle bundles by activated mast cells. We hypothesized that interactions between these cells promotes airway smooth muscle differentiation into a more contractile phenotype. In vitro coculture of human airway smooth muscle cells with β-tryptase, or mast cells with or without IgE/anti-IgE activation, increased airway smooth muscle-derived TGF-β1 secretion, α-smooth muscle actin expression and agonist-provoked contraction. This promotion to a more contractile phenotype was inhibited by both the serine protease inhibitor leupeptin and TGF-β1 neutralization, suggesting that the observed airway smooth muscle differentiation was driven by the autocrine release of TGF-β1 in response to activation by mast cell β-tryptase. Importantly, in vivo we found that in bronchial mucosal biopsies from asthmatics the intensity of α-smooth muscle actin expression was strongly related to the number of mast cells within or adjacent to an airway smooth muscle bundle. These findings suggest that mast cell localization in the airway smooth muscle bundle promotes airway smooth muscle cell differentiation into a more contractile phenotype, thus contributing to the disordered airway physiology that characterizes asthma.
PMCID: PMC3992381  PMID: 18802103
22.  The Faith, Activity, and Nutrition Program 
American journal of preventive medicine  2013;44(2):10.1016/j.amepre.2012.09.062.
Background
Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church.
Purpose
To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches.
Design
Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012.
Setting/participants
Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study.
Intervention
Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation.
Main outcome measures
Primary outcomes were self-reported moderate-to-vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers.
Results
There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p=0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p=0.03) and self-reported fruit and vegetable consumption (d=0.17, p=0.03). Trainings were evaluated very positively (training evaluation item means of 4.2–4.8 on a 5-point scale).
Conclusions
This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach.
Trial registration
This study is registered at www.clinicaltrials.gov NCT00379925.
doi:10.1016/j.amepre.2012.09.062
PMCID: PMC3884828  PMID: 23332327
23.  Study of Health and Activity in Preschool Environments (SHAPES): Study protocol for a randomized trial evaluating a multi-component physical activity intervention in preschool children 
BMC Public Health  2013;13:728.
Background
Physical inactivity is a recognized public health concern. Inadequate proportions of children in the U.S, including those of preschool age, are meeting physical activity recommendations. In response to low numbers of preschool children attaining appropriate physical activity levels, combined with the large number of young children who attend preschool, researchers have identified the need to devise interventions to increase physical activity at preschools. However, few multi-component interventions to increase physical activity in preschool children exist. The aims of this study were to observe the effects of a multi-component intervention on physical activity, sedentary behavior, and physical activity energy expenditure in 3-5 year-old children; identify factors that associate with change in those variables; and evaluate the process of implementing the multi-component intervention. The purpose of this manuscript is to describe the study design and intervention protocol.
Methods/design
The overall design of the Study of Health and Activity in Preschool Environments (SHAPES) was a two-year randomized trial (nested cohort design), with two conditions, two measurement occasions, and preschool serving as the unit of analysis. Sixteen schools (eight intervention and eight control) were enrolled. The intervention protocol was based on the social ecological model and included four main components: (a) indoor physical activity (“move inside”), (b) recess (“move outside”), (c) daily lessons (“move to learn”), and (d) social environment. Components were implemented using teacher and administrator trainings and workshops, site support visits, newsletters, and self-monitoring methods. Outcomes included accelerometer assessment of physical activity, sedentary behavior, and physical activity energy expenditure; weight status; and demographic factors; family/home social and physical environment; and parental characteristics. An extensive process evaluation battery was also used to monitor dose delivered by interventionists, completeness of intervention component delivery by teachers, and fidelity of teachers’ implementation.
Discussion
The study will address important gaps relative to increasing physical activity in preschool children. Few studies to date have incorporated a multi-component approach, rigorous measurement protocol, and thorough evaluation of intervention implementation.
Trial registration
NCT01885325
doi:10.1186/1471-2458-13-728
PMCID: PMC3751440  PMID: 23919808
Young children; Policy; Pre-K; School; Childcare
24.  Origins of increased airway smooth muscle mass in asthma 
BMC Medicine  2013;11:145.
Asthma is characterized by both chronic inflammation and airway remodeling. Remodeling - the structural changes seen in asthmatic airways - is pivotal in the pathogenesis of the disease. Although significant advances have been made recently in understanding the different aspects of airway remodeling, the exact biology governing these changes remains poorly understood. There is broad agreement that, in asthma, increased airway smooth muscle mass, in part due to smooth muscle hyperplasia, is a very significant component of airway remodeling. However, significant debate persists on the origins of these airway smooth muscle cells. In this review article we will explore the natural history of airway remodeling in asthma and we will discuss the possible contribution of progenitors, stem cells and epithelial cells in mesenchymal cell changes, namely airway smooth muscle hyperplasia seen in the asthmatic airways.
doi:10.1186/1741-7015-11-145
PMCID: PMC3688527  PMID: 23742314
Airway remodeling; Airway smooth muscle; Asthma; Fibrocytes; Mesenchymal stem cells
25.  Results of the “Active by Choice Today” (ACT) Randomized Trial for Increasing Physical Activity in Low-Income and Minority Adolescents 
Objective
This study reports the results of the “Active by Choice Today” (ACT) trial for increasing moderate-to-vigorous physical activity (MVPA) in low-income and minority adolescents.
Design
The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. Twenty-four middle schools were matched on school size, percentage minorities, percentage free or reduce lunch, and urban or rural setting before randomization. A total of 1,563 6th grade students (mean age, 11.3 years, 73% African American, 71% free or reduced lunch, 55% female) participated in either a 17-week (over one academic year) intervention or comparison after-school program.
Main Outcome Measure
The primary outcome measure was MVPA based on 7-day accelerometry estimates at 2-weeks postintervention and an intermediate outcome was MVPA at midintervention.
Results
At midintervention students in the intervention condition engaged in 4.87 greater minutes of MVPA per day (95% CI: 1.18 to 8.57) than control students. Students in intervention schools engaged in 9.11 min (95% CI: 5.73 to 12.48) more of MVPA per day than those in control schools during the program time periods; indicating a 27 min per week increase in MVPA. No significant effect of the ACT intervention was found outside of school times or for MVPA at 2-weeks postintervention.
Conclusions
Motivational and behavioral skills programs are effective at increasing MVPA in low-income and minority adolescents during program hours, but further research is needed to address home barriers to youth MVPA.
doi:10.1037/a0023390
PMCID: PMC3417297  PMID: 21534677
physical activity; adolescents; minorities; interventions

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