1. From Efficacy to Effectiveness: Using Pedometers to Increase Moderate Intensity Walking in a Community Sample of Hispanic Adults. Simon Marshall, Ph.D. San Diego Prevention Research Center San Diego State University An overview of SIP_09 (2004-2007)

2. About the SDPRC HP 2010, NAHH revisions HP 2010, NAHH revisions “Translate research into healthy practices that are meaningful to Latinos and that can be sustained through formal and informal community networks” “Physically Active, Healthy Latinos”

3. Pedometers and PA guidelines Pedometers alone appear insufficient to motivate long term behavior change Researchers & practitioners require guidelines for their use A continued criticism is that they are not designed to capture intensity Physical Activity among Hispanic/Latinos Hispanic/Latinos share a disproportionate burden of a sedentary lifestyle compared to other racial/ethnic groups Background to SIP 09 (04) 54% engaged in no LTPA (Whites = 36%; NHIS, 2002) 23% met 30 min/mod guidelines (Whites = 33%; NHIS, 2002) 59% of Mexican-Americans walked 0 days/month (NHANES III; 1988) 17% people walk when journey <1mile (NPTS, 1995)

4. The South Bay region of San Diego National City Chula Vista Imperial Beach San Ysidro

5. The San Ysidro Health Center, 1969 35,000 registered patients across 3 sites 82% Latino 54% live below the FPL …and in 2005

6. Specific Aim 1 Translate current physical activity recommendations into pedometer-based step indices. a. a.Objectively assess the number of steps taken in 30 minutes of moderate intensity physical activity under laboratory conditions. b. b.Objectively assess the number of steps taken in 30 minutes of (self-selected) moderate intensity physical activity under free-living conditions.

7. Phase 1 – Translate PA guidelines into pedometer-based step indices Community sample (n = 75+20; 18-55 yrs) from San Ysidro, National City, & Chula Vista. 4 x 5 minute bouts on level treadmill at 65, 80, 95, 110 m/min (~2.4 - 4.1 mph), respectively Oxygen uptake (VO 2 ) using indirect calorimetry HR, steps (pedometer), accelerometer counts (MTI dual mode Actigraph), RPE

8. Energy cost (MET) of walking = steady state VO 2 /3.5ml.kg -1.min -1 Energy cost (MET) of walking = steady state VO 2 /3.5ml.kg -1.min -1 Use bout closest to >3 MET’s in regression analysis to predict step rate. Use bout closest to >3 MET’s in regression analysis to predict step rate. Solve for step rate when MET = 3 (lower rate) and 5.99 (upper rate). Solve for step rate when MET = 3 (lower rate) and 5.99 (upper rate). Effects of age, stride length, trunk adiposity Effects of age, stride length, trunk adiposity Cross validate equation using holdout sample Cross validate equation using holdout sample Pedometer validity/reliability Pedometer validity/reliability Predict accelerometer counts/min from VO 2 Predict accelerometer counts/min from VO 2 Use to calibrate accelerometry in the field Use to calibrate accelerometry in the field Phase 1 – Translate PA guidelines into pedometer-based step indices

9. Do people walk at a moderate intensity when in a naturalistic environment? Do people walk at a moderate intensity when in a naturalistic environment? Participants walk on a neighborhood park for 30 minutes at self-defined “moderate (brisk) intensity” Participants walk on a neighborhood park for 30 minutes at self-defined “moderate (brisk) intensity” HR, step count (pedometer), accelerometer count HR, step count (pedometer), accelerometer count Use steps/min to predict accelerometer counts associated with moderate intensity walking Use steps/min to predict accelerometer counts associated with moderate intensity walking Phase 1b – Field condition of moderate intensity walking

10. Phase 2 – RCT Evaluate the effectiveness and sustainability of a pedometer-based walking intervention designed to increase levels of moderate intensity physical activity in an underserved Latino community sample

11. Cultural Considerations in Theory Application Theories of behavior change assume individuals are relatively autonomous Theories of behavior change assume individuals are relatively autonomous Inconsistent with strong sense of identification and attachment within Hispanic families; the “allocentric” society Inconsistent with strong sense of identification and attachment within Hispanic families; the “allocentric” society Perceived family support was most significant predictor of participation in heart health program (Apodaca et al., 1997) Perceived family support was most significant predictor of participation in heart health program (Apodaca et al., 1997)

12. Mediated Change via Promotoras(es) Origins in Latin America Origins in Latin America Acknowledges that health information is exchanged through formal and informal social networks Acknowledges that health information is exchanged through formal and informal social networks Indigenous lay health workers Indigenous lay health workers Members of existing valued social networks Empathic, friendly, compassionate, trusted, optimistic More adept at translating/trans-adapting health information Usually communicate face-to-face Provide instrumental support

13. INTERVENTION SCHEMATIC Recruit Promotora Director Recruit and train Promotoras Promotora-led activities emphasizing self-selected daily step goal, self- efficacy, & social support for walking (12 weeks) ACTIVITIES Promotora-led activities emphasizing static daily step goal, self-efficacy, & social support for walking (12 weeks) Promotora-led activities emphasizing cadence- based daily step goal, self- efficacy, & social support for walking (12 weeks) Three Primary Clinic Sites (k = 3) (San Ysidro, National City, Chula Vista) Conduct neighborhood walkability audit at each site Recruit participants (n = 165) (55 per site) Baseline walking assessment to recruit “low actives” (<7500 steps per day) Randomization of three clinic sites into Treatment Groups SELF-SELECTED (CONTROL) step goal (n = 55 participants) CADENCE step goal (x steps in 30 min) [3x10] (n = 55 participants) STATIC step goal (10,000 steps/day) (n = 55 participants) RANDOMIZED GROUPS Outcome Measures Minutes of Moderate Intensity PA per day; Steps/day, BMI, Resting HR, Waist & Hip Girth, SS, SE for walking OUTCOME EVALUATION @ T1 (baseline) T2 (post – Wk 12) T3 (f/up - Wk 24) Outcome Measures Minutes of Moderate Intensity PA per day; Steps/day, BMI, Resting HR, Waist & Hip Girth, SS, SE for walking Outcome Measures Minutes of Moderate Intensity PA per day; Steps/day, BMI, Resting HR, Waist & Hip Girth, SS, SE for walking

14. Program Evaluation Feasibility Feasibility Integrity Integrity Contextual factors Contextual factors Participant factors Participant factors Development of Promotora training manual