Major and minor life events as predictors of medical utilization

Research suggests stressful life events can negatively influence physical and mental health in a number of ways. While previous research indicates both major and minor life events contribute unique variance to the prediction of physical and mental symptoms, little research has examined the relationships of both major and minor life events with medical utilization. The current study included a predominantly African American, low-income sample of adults (N = 207) attending two primary care outpatient clinics and assessed their experience of both major and minor life events over the course of one year. Medical utilization data were collected over a subsequent four-year period and included total utilization, outpatient visits, emergency department visits, and hospitalizations. Hierarchical multiple regressions were used to determine if the frequency and perceived impact of major and minor stressful events predicted subsequent medical utilization in this sample of primary care patients. After controlling for age, gender, ethnicity, and number of chronic illnesses, none of the stress measures showed a significant relationship to any type of utilization in the sample as a whole. When examining only patients from the family practice clinic who had access to a regular primary care physician (N = 141), the perceived impact of minor life events made unique contributions in predicting total medical utilization and outpatient visits, such that higher perceived impact was associated with higher rates of medical services use. The frequency of minor life events was also a significant predictor of outpatient visits, with more frequent minor life events associated with greater utilization. Neither the frequency nor impact of major life events was predictive of utilization. Results indicate minor life events may influence medical utilization for some patients, although access to medical care appears to be an important variable affecting this relationship

Effects of a primary care weight management intervention on physical activity in low-income African American women

Although physical inactivity is associated with numerous medical conditions, most individuals do not engage in recommended levels of physical activity. Certain subgroups of the population are particularly inactive, including women, African Americans, and individuals with lower income and less education. While research suggests that interventions targeting physical activity can produce significant improvements in activity and cardiorespiratory fitness, there is less research examining physical activity interventions for these at-risk groups. In particular, there is a lack of research examining primary care physical activity interventions among low-income, African American women. The purpose of the current study was to examine the effects of a physician-delivered physical activity intervention that served as part of a multi-component weight loss intervention for predominantly low-income, African American women. Current results suggest that the primary care intervention did not produce significant improvements in physical activity as measured by self-reported activity. Also, the intervention was not associated with improved cardiorespiratory fitness as measured by heart rate recovery following a brief exercise. However, a significantly greater proportion of intervention participants achieved current activity recommendations of at least 150 minutes per week of moderate-intensity physical activity. Over 90% of intervention participants achieved this level of activity at post-treatment compared with approximately 77% of standard care participants, χ2(1, N = 139) = 4.70, p \u3c .03. These mixed results highlight the need for continued research examining physical activity interventions implemented in primary care settings as well as programs targeting low-income, African Americans

Relationship of Physical Performance with Body Composition and Bone Mineral Density in Individuals over 60 Years of Age: A Systematic Review

The purpose of this review was to examine the relationship between physical performance and body composition measurements, including fat/muscle mass and bone mineral density (BMD) in individuals ≥60 years of age. Various measurements used to assess body composition, BMD, and physical performance (PP) were discussed as well. Medline/PubMed, CINAHL, and SCIE were used to identify articles. After limiting the search for age and kind of physical performance measures, 33 articles were evaluated. Higher fat mass was associated with poorer physical performance while higher muscle mass was a predictor of better physical performance, especially in the lower extremities. Additionally, evidence showed that higher muscle fat infiltration was a determinant of poorer physical performance. BMD was shown to be a good predictor of physical performance although the relationship was stronger in women than in men. Developing standardized methods for PP measurements could help in further investigation and conclusions of its relationship with body composition

Physical Activity and Social Cognitive Theory Outcomes of an Internet-Enhanced Physical Activity Intervention for African American Female College Students

Background. African American women report low levels of physical activity (PA) and are disproportionately burdened by related chronic diseases. This pilot study tested a 6-month theory-based (Social Cognitive Theory, SCT) culturally-relevant website intervention to promote PA among African American female college students. Materials and Methods. A single group pre-post test design (n=34) was used. PA and associated SCT constructs (outcome expectations, enjoyment, self-regulation, social support) were assessed at baseline, 3 months and 6 months. Results. The sample was comprised of mostly obese (M BMI= 35.4, SD=6.82) young adults (M age= 21.21 years, SD=2.31). Fifty percent of the sample completed all assessments. Intent-to-treat analyses showed that participants reported a significant median improvement in moderate-to-vigorous physical activity from 82.5 minutes/week (M=81.76, SD=76.23) at baseline to 115.0 minutes/week (M=122.44,SD=97.93) at 3 months (Wilcoxon z=2.39, p=.02). However these gains appear to have attenuated by 6 months (Median= 82.5 minutes/week, M=96.73, SD=84.20; Wilcoxon z=1.02, p=.31). Significant increases from baseline to 6 months were found in self-regulation for PA (p=.02) and social support for PA from friends (p=.02). Changes in the SCT variables were not significantly associated with changes in PA; however, this may have been due to small sample size. Conclusions. Future studies with larger samples and more aggressive retention strategies (e.g., more frequent incentives, prompts for website use) are needed to further explore the applicability of culturally relevant web-based approaches to promote PA in this at-risk population

Feasibility, acceptability, and characteristics associated with adherence and completion of a culturally relevant internet-enhanced physical activity pilot intervention for overweight and obese young adult African American women enrolled in college

BACKGROUND: African American women are one of the least active demographic groups in the US, with only 36% meeting the national physical activity recommendations in comparison to 46% of White women. Physical activity begins to decline in African American women in adolescence and continues to decline into young adulthood. Yet, few interventions have been developed to promote physical activity in African American women during this critical period of life. The purpose of this article was to evaluate the acceptability and feasibility of a culturally-relevant Internet-enhanced physical activity pilot intervention for overweight/obese African American college females and to examine psychosocial and behavioral characteristics associated with intervention adherence and completion. METHODS: A 6-month single group pre-posttest design was used. Participants (n = 27) accessed a culturally-relevant Social Cognitive Theory-based physical activity promotion website while engaging in a minimum of four moderate-intensity physical activity sessions each week. Acceptability and feasibility of the intervention was assessed by participant retention and a consumer satisfaction survey completed by participants. RESULTS: Fifty-six percent of participants (n = 15) completed the intervention. Study completers were more physically active at baseline (P = 0.05) and had greater social support for exercise from family members (P = 0.04). Sixty percent of study completers (n = 9) reported the website as enjoyable or very enjoyable to use and 60% (n = 9) reported increased motivation from participation in the physical activity program. Moreover, 87% (n = 13) reported they would recommend the website to a friend. CONCLUSIONS: Results provide some preliminary support for the acceptability and feasibility of an Internet-enhanced physical activity program for overweight/obese African American women, while highlighting important limitations of the approach. Successful promotion of physical activity in college aged African American women as they emerge into adulthood may result in the development of life-long healthy physical activity patterns which may ultimately reduce physical activity-related health disparities in this high risk underserved population. Future studies with larger samples are needed to further explore the use of Internet-based programs to promote physical activity in this population

Ideal weight goals of African American women participating in a weight management program

This descriptive study examined the ideal weight goals of low-income African American women enrolled in a weight loss intervention. Prior to treatment, 107 overweight African American women were weighed, heights were measured, and participants completed a self-report measure of various weight-related variables (e.g., ideal goal weight, amount lost with previous attempts). The average baseline body mass index (BMI) was 38.8kg/m(2). The average ideal BMI was 27.2kg/m(2), which would require a 29.2% reduction in weight. Ideal weight loss was approximately 25kg greater than that achieved during past attempts. Results suggest this ethnic minority sample demonstrated satisfaction with achieving an ideal weight still classified as overweight. However, the percentage of weight loss required to reach such goals is much greater than that recommended by expert guidelines. Although future research is needed, weight loss interventionists may need to address African American women\u27s acceptance of heavier weight when treating their obesity

Self-efficacy as a predictor of weight change in African-American women

OBJECTIVE: Although self-efficacy has received increasing attention for its role in weight loss, there is less research examining this relationship in minority samples. The purpose of this study was to determine whether self-efficacy for weight loss was predictive of weight change in a sample of African-American women. RESEARCH METHODS AND PROCEDURES: Subjects were 106 overweight or obese, low-income African-American women participating in a weight management intervention that involved either personalized monthly sessions with their primary care physician or standard care. Weight and self-efficacy for weight loss were assessed at baseline and at the end of the 6-month treatment. RESULTS: For subjects in the personalized intervention, baseline self-efficacy was predictive of subsequent weight change, such that higher levels of self-efficacy before treatment were associated with less weight loss. In contrast, improvements in self-efficacy during treatment were associated with greater weight loss for the personalized intervention group. DISCUSSION: Results suggest high self-efficacy for weight loss before treatment may be detrimental to success, whereas treatments that improve participants\u27 self-efficacy may result in greater weight loss. High pretreatment self-efficacy may be indicative of overconfidence or lack of experience with the difficulties associated with weight loss efforts. Whereas replication is needed, our results suggest that self-efficacy is an important variable to consider when implementing weight loss interventions