Biomedical subjects

J J Prochaska

Publications and source records attributed to J J Prochaska.

9 recordsLinked to original sources

PubMed2001

A physical activity screening measure for use with adolescents in primary care.

OBJECTIVE: To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings. STUDY DESIGN: We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity. RESULTS: In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable. CONCLUSION: The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.

Adolescent↗

PubMed2001

A multicomponent program for nutrition and physical activity change in primary care: PACE+ for adolescents.

BACKGROUND: Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. PARTICIPANTS: Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. INTERVENTION: Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. MEASURES: Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. RESULTS: All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. CONCLUSIONS: A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Adolescent↗

PubMed2001

Screening measure for assessing dietary fat intake among adolescents.

BACKGROUND: Clinical preventive guidelines recommend that health care providers counsel adolescents on nutrition. Brief, accurate, and reproducible dietary assessments are needed. The purpose of the current pair of studies was to develop a dietary fat screening measure for use with adolescents. METHODS: Two measures were developed-a 21-item and a 4-category measure. The measures differed in the level at which fat consumption was assessed (food item vs food group). Study 1 (N = 231, age M = 15 years, 57% female, 41% Euro-American) evaluated reliability. Study 2 (N = 59, age M = 14 years, 63% female, 37% Euro-American) evaluated construct validity and correct classification rates. RESULTS: Internal consistencies (alpha > 0.70) and test-retest reliabilities (ICC > 0.60) were adequate for both measures. Neither measure correlated with total fat assessed by a 3-day food record (P > 0.05). The 21-item measure correlated significantly with percentage of calories from fat (r = 0.36, P <.01). Correct classification rate (71%) and sensitivity (81%) of the 21-item measure were good. Specificity (47%) was lower, indicating some subjects with a low-fat diet were misclassified by the screening measure. CONCLUSIONS: The 21-item measure is quick to complete and score, is inexpensive to reproduce, and has demonstrated reliability and validity. The measure could be clinically useful, but further improvements should be attempted to improve specificity.

Adolescent↗

PubMed2001

The association of school environments with youth physical activity.

OBJECTIVES: This study assessed the association of school environmental characteristics with student physical activity on campus. METHODS: Physical activity areas (n = 137) at 24 public middle schools were assessed for area type, size, and improvements (e.g., basketball courts). Student physical activity and the presence of equipment and supervision were directly observed before school, after lunch, and after school. RESULTS: Environmental characteristics explained 42% of the variance in the proportion of girls who were physically active and 59% of the variance for boys. CONCLUSIONS: School environments with high levels of supervision and improvements stimulated girls and boys to be more physically active.

Adolescent↗

PubMed2000

PACE+: interactive communication technology for behavior change in clinical settings.

BACKGROUND: Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults. METHODS: The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers. RESULTS: The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified. CONCLUSIONS: Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.

Adolescent↗

PubMed2000

Examination of the factor structure of physical activity behaviors.

Multiple physical activity recommendations exist for behaviors that vary in type and intensity (e.g., vigorous physical activity, strengthening exercises, moderate physical activity). The present study examined underlying dimensions of physical activity behaviors and determined the extent to which factors correspond to national health recommendations. Fifteen variables were drawn from six self-report measures and subjected to factor analysis with quartimax rotation. Participants were 547 university seniors (56% female; 60% Caucasian; mean age = 25 years). TV watching, the only index of sedentary behavior, did not load highly with other items, and was analyzed separately. Three interpretable factors were found: variables related to vigorous physical activity loaded highly on Factor 1; flexibility and strengthening items loaded highly on Factor 2; and moderate and housework activity loaded highly on Factor 3. Factors corresponded closely to national recommendations. Unweighted factor scores and TV watching correlated significantly with physiological indicators of fitness, supporting construct validity.

Adolescent↗

PubMed2000

A review of correlates of physical activity of children and adolescents.

BACKGROUND: Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results. METHODS: A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents. RESULTS: About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise. CONCLUSION: These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.

Adolescent↗

PubMed1999

Correlates of physical activity in a national sample of girls and boys in grades 4 through 12.

Psychological, biological, social, and physical environmental variables were examined for their association with physical activity of young people. A national sample of 1,504 parents and children in Grades 4-12 were interviewed by telephone. Twenty-two potential determinants were assessed along with an 11-item child physical activity index (alpha = .76). Hierarchical multiple regressions were conducted separately for 6 age-sex subgroups. Percentage of variance explained ranged from 18% for boys in Grades 4-6 to 59% for girls in Grades 10-12. Three variables had strong and consistent associations with the child physical activity index that generalized across subgroups: use of afternoon time for sports and physical activity, enjoyment of physical education, and family support for physical activity. These 3 variables should be targeted for change to promote physical activity in all groups of young people.

Adolescent↗

PubMedDate not supplied

Depression and stages of change for smoking in psychiatric outpatients.

This article reports on the relations between depression and stages of change for smoking cessation. A convenience sample of 205 psychiatric outpatients (68% female, mean age 41) completed measures of depression Primary Care Evaluation of Mental Disorders [PRIME-MD] and Beck Depression Inventory-II [BDI-II]), all transtheoretical model constructs related to smoking (stages and processes of change, pros and cons of smoking, and situational temptations), and thoughts about abstinence. As hypothesized, patients who had never smoked showed substantially lower rates of currently diagnosed major depressive disorder (MDD) than those who had ever smoked. Patients in early stages of change did not show more MDD or depressive symptoms but, as hypothesized, showed more negative thoughts about abstinence. Findings are consistent with the documented association between smoking and depression and suggest the appropriateness of building smoking cessation interventions based on the transtheoretical model of change for use with psychiatric populations.

Adult↗