Commentary on Future of Health Behavior Research: Aging Perspectives

This Commentary provides personal reflections on the future of health behavior research and the role of AAHB in the preparation of the next generation of researchers and educators for high quality relevant research and practice. Comments center around the four questions presented to Research Laureates at the 2017 AAHB Annual Meeting. Themes include: 1) a life-course perspective as a priority game changer in furthering health behavior research; 2) multiple disciplines to advance health behavior research; 3) pathways to a successful doctoral program; and 4) forward thinking for identifying risk factors for public health problems and contextually-based health behavior solutions

Evidence-Based Programming for Older Adults

There is increased world-wide concern about the impact of multiple chronic conditions, especially among the rapidly aging population. Simultaneously, over the past decade there has been an emergence of state-wide and national initiatives to reduce the burden of chronic conditions that draw upon the translation of evidence-based programs (EPB) into community practice. Yet, little has been written about the national and international implementation, dissemination, and sustainability of such programs. This Research Topic features articles about EBPs for older adults, including a range of articles that focus on the infrastructure needed to widely disseminate EBP as well as individual participant impacts on physical, mental, and social aspects of health and well-being. Using a pragmatic research perspective, this Research Topic will advance knowledge that aims to enhance practice, inform policy and build systems of support and delivery in regard to the reach, effectiveness, adoption, implementation, and maintenance of evidence-based interventions for older adults. The focus is on knowledge transfer rather than knowledge generation but with a dual emphasis on the dissemination and sustainability of EBP that have been tested and shown effective as well as the adaptation of practice-based interventions into evidence-based programs. This Research Topic draws upon grand-scale efforts to deliver these programs, and include both U.S. as well as international examples. Commentaries discuss processes in the development and measurement of EBP and reflect perspectives from program developers and major national and regional funders of EBP as well as professionals and practitioners in the field. The full-length articles focus on four major programmatic areas: (1) chronic disease self-management programs; (2) fall prevention programs; (3) general wellness and physical activity programs; and (4) mental health programs. Additionally, articles are included to discuss cross-cutting issues related to building partnerships and the research infrastructure for the implementation, evaluation, and dissemination of evidence-based programming. The intent of this Research Topic is to enhance practice, inform policy, and build systems of support and delivery for EBP. It is written for a diverse audience and contains practical implications and recommendations for introducing, delivering, and sustaining EBP in a multitude of settings

Parental safety concerns and active school commute: correlates across multiple domains in the home-to-school journey

Abiodun O. Oluyomi, Eileen Nehme, and Deanna M. Hoelscher are with The Michael and Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, The University of Texas Health Science Center at Houston, Austin, TX USA -- Chanam Lee is with the Department of Landscape Architecture and Urban Planning, College of Architecture, Texas AM University, College Station, TX USA -- Diane Dowdy and Marci G. Ory are with the School of Rural Public Health, Texas AM HeaBackground: Empirical evidence of the relationship between safety concerns and walking to school (WTS) is growing. However, current research offers limited understanding of the multiple domains of parental safety concerns and the specific mechanisms through which parents articulate safety concerns about WTS. A more detailed understanding is needed to inform environmental and policy interventions. This study examined the relationships between both traffic safety and personal safety concerns and WTS in the U.S. Methods: This cross-sectional analysis examined data from the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, an evaluation of state-wide obesity prevention policy interventions. All study data were from the survey (n = 830) of parents with 4th grade students attending 81 elementary schools across Texas, and living within two miles from their children's schools. Traffic safety and personal safety concerns were captured for the home neighborhood, en-route to school, and school environments. Binary logistic regression analysis was used to assess the odds of WTS controlling for significant covariates. Results: Overall, 18% of parents reported that their child walked to school on most days of the week. For traffic safety, students were more likely to walk to school if their parent reported favorable perceptions about the following items in the home neighborhood environment: higher sidewalk availability, well maintained sidewalks and safe road crossings. For the route to school, the odds of WTS were higher for those who reported "no problem" with each one of the following: traffic speed, amount of traffic, sidewalks/pathways, intersection/crossing safety, and crossing guards, when compared to those that reported "always a problem". For personal safety in the en-route to school environment, the odds of WTS were lower when parents reported concerns about: stray or dangerous animals and availability of others with whom to walk. Conclusions: Findings offered insights into the specific issues that drive safety concerns for elementary school children’s WTS behaviors. The observed associations between more favorable perceptions of safety and WTS provide further justification for practical intervention strategies to reduce WTS barriers that can potentially bring long-term physical activity and health benefits to school-aged children.Public [email protected]

Mexican Americans With Type 2 Diabetes: Perspectives on Definitions, Motivators, and Programs of Physical Activity

IntroductionResearch documents that Mexican Americans bear excess health risk because of physical inactivity and have higher morbidity and mortality rates from chronic diseases than do other ethnic groups. Factors influencing physical activity in this minority population, however, are not well understood. This study examines perceptions of physical activity in a population of Mexican Americans who have type 2 diabetes and live in the Texas-Mexico border region and identifies motivators and barriers to physical activity in this group.MethodsThis study used a qualitative research design and employed six focus groups comprising 39 Mexican Americans with type 2 diabetes who live in the Texas–Mexico border region. A team of bilingual Mexican American researchers systematically reviewed and analyzed focus group data by means of qualitative data analysis software. The study was conducted during 2005–2006.ResultsMost participants considered physical activity to be related not only to exercise but also to occupational and home activities. Walking was the preferred type of activity. Motivators to physical activity included family support and the sense of well-being derived from physical activity. Barriers to physical activity included individual and environmental factors, such as lack of time, physical pain, depression, being overweight, unsafe neighborhoods, and lack of facilities. Participants suggested that the ideal intervention would be low in cost, family-based, close to home, and led by bilingual instructors.ConclusionHealth promotion efforts to prevent or reduce the effects of chronic disease among Mexican Americans with type 2 diabetes in the Texas–Mexico border region should focus on implementing neighborhood-based, family-oriented walking interventions

Factors Associated with Women’s Chronic Disease Management: Associations of Healthcare Frustrations, Physician Support, and Self-Care Needs

Previous research emphasizes the importance of reducing healthcare frustrations and enhancing physician supports to help patients engage in recommended healthcare regimens. However, less is known about how these factors are associated with aging women's knowledge about self-care behavior. This study examined the sociodemographics, health indicators, healthcare-related frustrations, and perceptions of physician support associated with middle-aged and older adult females' self-reported need for help to learn how to take better care of their health. Data were analyzed from 287 females with one or more chronic conditions who completed The National Council on Aging (NCOA) Chronic Care Survey. A logistic regression model was developed. Women who were non-White (OR = 2.26, P = 0.049) were more likely to need help learning how to better manage their health. Those who had some college education or more (OR = 0.55, P = 0.044) and lower healthcare-related frustrations (OR = 0.44, P = 0.017) and perceived to have more physician support (OR = 0.49, P = 0.033) were less likely to need help learning how to better manage their health. Findings can inform the planning, implementation, assessment, and dissemination of evidence-based self-management programs for middle-aged and older women within and outside of clinical settings

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Evidence-Based Program to Reduce Fall-Related Risk Among Older Adults: A Comparison of Program Efficacy by Ethnicity

Despite rapid growth among the Hispanic population in the United States, seniors within this ethnic group are typically underrepresented in evidence-based programs. The purpose of this study is to examine the relative efficacy of A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), an eight session fall risk prevention program, for non-Hispanic White and English-speaking Hispanic participants on key study outcomes. Data were collected from 1,233 seniors enrolled in AMOB/VLL in Texas. Compared to non-Hispanic White participants, a significantly larger proportion of Hispanic participants were younger (?2=50.23, df=3, p<0.001), had less than a high school education (?2=200.31, df=2, p<0.001), and resided in less affluent areas. From baseline to post-intervention, significant improvements in falls efficacy (t=- 9.13, df=167, p<0.001), days limited from usual activity (t=1.99, df=164, p=0.049), and unhealthy mental days (t=2.51, p=0.013) were seen among Hispanic participants. Significant improvements among nonHispanic White participants were observed for falls efficacy (t=-15.90, df=868, p<0.001). Although significant improvements were found for each ethnic group, the magnitude of improvement among Hispanic participants exceeded that of non-Hispanic Whites in some aspects. Identifying participant characteristics and positive outcomes specific to Hispanics can inform strategies to maximize program reach and effectiveness among this vulnerable and underserved population

Fingering Instability in Combustion

A thin solid (e.g., paper), burning against an oxidizing wind, develops a fingering instability with two decoupled length scales. The spacing between fingers is determined by the P\'eclet number (ratio between advection and diffusion). The finger width is determined by the degree two dimensionality. Dense fingers develop by recurrent tip splitting. The effect is observed when vertical mass transport (due to gravity) is suppressed. The experimental results quantitatively verify a model based on diffusion limited transport

Otago Exercise Program in the United States: Comparison of 2 Implementation Models

Author(s): Shubert, TE; Smith, ML; Goto, L; Jiang, L; Ory, M