ASU Scholarship Showcase

Background: An evidence-based steps/day translation of U.S. federal guidelines for youth to engage in ≥60 minutes/day of moderate-to-vigorous physical activity (MVPA) would help health researchers, practitioners, and lay professionals charged with increasing youth’s physical activity (PA). The purpose of this study was to determine the number of free-living steps/day (both raw and adjusted to a pedometer scale) that correctly classified children (6–11 years) and adolescents (12–17 years) as meeting the 60-minute MVPA guideline using the 2005–2006 National Health and Nutrition Examination Survey (NHANES) accelerometer data, and to evaluate the 12,000 steps/day recommendation recently adopted by the President’s Challenge Physical Activity and Fitness Awards Program.

Methods: Analyses were conducted among children (n = 915) and adolescents (n = 1,302) in 2011 and 2012. Receiver Operating Characteristic (ROC) curve plots and classification statistics revealed candidate steps/day cut points that discriminated meeting/not meeting the MVPA threshold by age group, gender and different accelerometer activity cut points. The Evenson and two Freedson age-specific (3 and 4 METs) cut points were used to define minimum MVPA, and optimal steps/day were examined for raw steps and adjusted to a pedometer-scale to facilitate translation to lay populations.

Results: For boys and girls (6–11 years) with ≥ 60 minutes/day of MVPA, a range of 11,500–13,500 uncensored steps/day for children was the optimal range that balanced classification errors. For adolescent boys and girls (12–17) with ≥60 minutes/day of MVPA, 11,500–14,000 uncensored steps/day was optimal. Translation to a pedometer-scaling reduced these minimum values by 2,500 step/day to 9,000 steps/day. Area under the curve was ≥84% in all analyses.

Conclusions: No single study has definitively identified a precise and unyielding steps/day value for youth. Considering the other evidence to date, we propose a reasonable ‘rule of thumb’ value of ≥ 11,500 accelerometer-determined steps/day for both children and adolescents (and both genders), accepting that more is better. For practical applications, 9,000 steps/day appears to be a more pedometer-friendly value.

Background: The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden.

Methods: We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization.

Results: Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south–north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918–19, but different factors explained mortality variation in each wave.

Conclusions: A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918-19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality.

Background: Many studies used the older ActiGraph (7164) for physical activity measurement, but this model has been replaced with newer ones (e.g., GT3X+). The assumption that new generation models are more accurate has been questioned, especially for measuring lower intensity levels. The low-frequency extension (LFE) increases the low-intensity sensitivity of newer models, but its comparability with older models is unknown. This study compared step counts and physical activity collected with the 7164 and GT3X + using the Normal Filter and the LFE (GT3X+N and GT3X+LFE, respectively).

Findings: Twenty-five adults wore 2 accelerometer models simultaneously for 3Âdays and were instructed to engage in typical behaviors. Average daily step counts and minutes per day in nonwear, sedentary, light, moderate, and vigorous activity were calculated. Repeated measures ANOVAs with post-hoc pairwise comparisons were used to compare mean values. Means for the GT3X+N and 7164 were significantly different in 4 of the 6 categories (p < .05). The GT3X+N showed 2041 fewer steps per day and more sedentary, less light, and less moderate than the 7164 (+25.6, -31.2, -2.9 mins/day, respectively). The GT3X+LFE showed non-significant differences in 5 of 6 categories but recorded significantly more steps (+3597 steps/day; p < .001) than the 7164.

Conclusion: Studies using the newer ActiGraphs should employ the LFE for greater sensitivity to lower intensity activity and more comparable activity results with studies using the older models. Newer generation ActiGraphs do not produce comparable step counts to the older generation devices with the Normal filter or the LFE.

Background: Public parks can be an important setting for physical activity promotion, but to increase park use and the activity levels of park users, the crucial attributes related to active park use need to be defined. Not only user characteristics and structural park attributes, but also characteristics of the surrounding neighborhood are important to examine. Furthermore, internationally comparable studies are needed, to find out if similar intervention strategies might be effective worldwide. The main aim of this study was to examine whether the overall number of park visitors and their activity levels depend on study site, neighborhood walkability and neighborhood income.

Methods: Data were collected in 20 parks in Ghent, Belgium and San Diego, USA. Two trained observers systematically coded park characteristics using the Environmental Assessment of Public Recreation Spaces (EAPRS) tool, and park user characteristics using the System for Observing Play and recreation in Communities (SOPARC) tool. Multilevel multiple regression models were conducted in MLwiN 2.25.

Results: In San Diego parks, activity levels of park visitors and number of vigorously active visitors were higher than in Ghent, while the number of visitors walking and the overall number of park visitors were lower. Neighborhood walkability was positively associated with the overall number of visitors, the number of visitors walking, number of sedentary visitors and mean activity levels of visitors. Neighborhood income was positively associated with the overall number of visitors, but negatively with the number of visitors being vigorously active.

Conclusions: Neighborhood characteristics are important to explain park use. Neighborhood walkability-related attributes should be taken into account when promoting the use of existing parks or creating new parks. Because no strong differences were found between parks in high- and low-income neighborhoods, it seems that promoting park use might be a promising strategy to increase physical activity in low-income populations, known to be at higher risk for overweight and obesity.

Background: Ebola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%. The 2014 West African outbreaks are the largest and worst in history. There is no specific treatment or effective/safe vaccine against the disease. Hence, control efforts are restricted to basic public health preventive (non-pharmaceutical) measures. Such efforts are undermined by traditional/cultural belief systems and customs, characterized by general mistrust and skepticism against government efforts to combat the disease. This study assesses the roles of traditional customs and public healthcare systems on the disease spread.

Methods: A mathematical model is designed and used to assess population-level impact of basic non-pharmaceutical control measures on the 2014 Ebola outbreaks. The model incorporates the effects of traditional belief systems and customs, along with disease transmission within health-care settings and by Ebola-deceased individuals. A sensitivity analysis is performed to determine model parameters that most affect disease transmission. The model is parameterized using data from Guinea, one of the three Ebola-stricken countries. Numerical simulations are performed and the parameters that drive disease transmission, with or without basic public health control measures, determined. Three effectiveness levels of such basic measures are considered.

Results: The distribution of the basic reproduction number (R_0) for Guinea (in the absence of basic control measures) is such that R_ 0 ∈ [0.77,1.35], for the case when the belief systems do not result in more unreported Ebola cases. When such systems inhibit control efforts, the distribution increases to R_ 0 ∈ [1.15,2.05]. The total Ebola cases are contributed by Ebola-deceased individuals (22%), symptomatic individuals in the early (33%) and latter (45%) infection stages. A significant reduction of new Ebola cases can be achieved by increasing health-care workers’ daily shifts from 8 to 24 hours, limiting hospital visitation to 1 hour and educating the populace to abandon detrimental traditional/cultural belief systems.

Conclusions: The 2014 outbreaks are controllable using a moderately-effective basic public health intervention strategy alone. A much higher (>50%) disease burden would have been recorded in the absence of such intervention.

Background: Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics.

Methods: We use individual-level clinical data on a large series of ARI (acute respiratory infection) hospitalizations from a prospective surveillance system of the Mexican Social Security medical system to analyze clinical features at presentation, admission delays, selected comorbidities and receipt of seasonal vaccine on the risk of A/H1N1-related death. We considered ARI hospitalizations and inpatient-deaths, and recorded demographic, geographic, and medical information on individual patients during August-December, 2009.

Results: Seasonal influenza vaccination was associated with a reduced risk of death among A/H1N1 inpatients (OR = 0.43 (95% CI: 0.25, 0.74)) after adjustment for age, gender, geography, antiviral treatment, admission delays, comorbidities and medical conditions. However, this result should be interpreted with caution as it could have been affected by factors not directly measured in our study. Moreover, the effect of antiviral treatment against A/H1N1 inpatient death did not reach statistical significance (OR = 0.56 (95% CI: 0.29, 1.10)) probably because only 8.9% of A/H1N1 inpatients received antiviral treatment. Moreover, diabetes (OR = 1.6) and immune suppression (OR = 2.3) were statistically significant risk factors for death whereas asthmatic persons (OR = 0.3) or pregnant women (OR = 0.4) experienced a reduced fatality rate among A/H1N1 inpatients. We also observed an increased risk of death among A/H1N1 inpatients with admission delays >2 days after symptom onset (OR = 2.7). Similar associations were also observed for A/H1N1-negative inpatients.

Conclusions: Geographical variation in identified medical risk factors including prevalence of diabetes and immune suppression may in part explain between-country differences in pandemic mortality burden. Furthermore, access to care including hospitalization without delay and antiviral treatment and are also important factors, as well as vaccination coverage with the 2008–09 trivalent inactivated influenza vaccine.

The unicellular green microalga Desmodesmus sp. S1 can produce more than 50% total lipid of cell dry weight under high light and nitrogen-limitation conditions. After irradiation by heavy ¹²C⁶⁺ ion beam of 10, 30, 60, 90 or 120 Gy, followed by screening of resulting mutants on 24-well microplates, more than 500 mutants were obtained. One of those, named D90G-19, exhibited lipid productivity of 0.298 g L^-1⋅d^-1, 20.6% higher than wild type, likely owing to an improved maximum quantum efficiency (Fv/Fm) of photosynthesis under stress. This work demonstrated that heavy-ion irradiation combined with high-throughput screening is an effective means for trait improvement. The resulting mutant D90G-19 may be used for enhanced lipid production.

The 1918 influenza pandemic was a major epidemiological event of the twentieth century resulting in at least twenty million deaths worldwide; however, despite its historical, epidemiological, and biological relevance, it remains poorly understood. Here we examine the relationship between annual pneumonia and influenza death rates in the pre-pandemic (1910–17) and pandemic (1918–20) periods and the scaling of mortality with latitude, longitude and population size, using data from 66 large cities of the United States. The mean pre-pandemic pneumonia death rates were highly associated with pneumonia death rates during the pandemic period (Spearman ρ = 0.64–0.72; P<0.001). By contrast, there was a weak correlation between pre-pandemic and pandemic influenza mortality rates. Pneumonia mortality rates partially explained influenza mortality rates in 1918 (ρ = 0.34, P = 0.005) but not during any other year. Pneumonia death counts followed a linear relationship with population size in all study years, suggesting that pneumonia death rates were homogeneous across the range of population sizes studied. By contrast, influenza death counts followed a power law relationship with a scaling exponent of ∼0.81 (95%CI: 0.71, 0.91) in 1918, suggesting that smaller cities experienced worst outcomes during the pandemic. A linear relationship was observed for all other years. Our study suggests that mortality associated with the 1918–20 influenza pandemic was in part predetermined by pre-pandemic pneumonia death rates in 66 large US cities, perhaps through the impact of the physical and social structure of each city. Smaller cities suffered a disproportionately high per capita influenza mortality burden than larger ones in 1918, while city size did not affect pneumonia mortality rates in the pre-pandemic and pandemic periods.

Background: The World Health Organization recommends strategies to improve urban design, public transportation, and recreation facilities to facilitate physical activity for non-communicable disease prevention for an increasingly urbanized global population. Most evidence supporting environmental associations with physical activity comes from single countries or regions with limited variation in urban form. This paper documents variation in comparable built environment features across countries from diverse regions.

Methods: The International Physical Activity and the Environment Network (IPEN) study of adults aimed to measure the full range of variation in the built environment using geographic information systems (GIS) across 12 countries on 5 continents. Investigators in Australia, Belgium, Brazil, Colombia, the Czech Republic, Denmark, China, Mexico, New Zealand, Spain, the United Kingdom, and the United States followed a common research protocol to develop internationally comparable measures. Using detailed instructions, GIS-based measures included features such as walkability (i.e., residential density, street connectivity, mix of land uses), and access to public transit, parks, and private recreation facilities around each participant’s residential address using 1-km and 500-m street network buffers.

Results: Eleven of 12 countries and 15 cities had objective GIS data on built environment features. We observed a 38-fold difference in median residential densities, a 5-fold difference in median intersection densities and an 18-fold difference in median park densities. Hong Kong had the highest and North Shore, New Zealand had the lowest median walkability index values, representing a difference of 9 standard deviations in GIS-measured walkability.

Conclusions: Results show that comparable measures can be created across a range of cultural settings revealing profound global differences in urban form relevant to physical activity. These measures allow cities to be ranked more precisely than previously possible. The highly variable measures of urban form will be used to explain individuals’ physical activity, sedentary behaviors, body mass index, and other health outcomes on an international basis. Present measures provide the ability to estimate dose–response relationships from projected changes to the built environment that would otherwise be impossible.

Background: Advancements in geographic information systems over the past two decades have increased the specificity by which an individual’s neighborhood environment may be spatially defined for physical activity and health research. This study investigated how different types of street network buffering methods compared in measuring a set of commonly used built environment measures (BEMs) and tested their performance on associations with physical activity outcomes.

Methods: An internationally-developed set of objective BEMs using three different spatial buffering techniques were used to evaluate the relative differences in resulting explanatory power on self-reported physical activity outcomes. BEMs were developed in five countries using ‘sausage,’ ‘detailed-trimmed,’ and ‘detailed,’ network buffers at a distance of 1 km around participant household addresses (n = 5883).

Results: BEM values were significantly different (p < 0.05) for 96% of sausage versus detailed-trimmed buffer comparisons and 89% of sausage versus detailed network buffer comparisons. Results showed that BEM coefficients in physical activity models did not differ significantly across buffering methods, and in most cases BEM associations with physical activity outcomes had the same level of statistical significance across buffer types. However, BEM coefficients differed in significance for 9% of the sausage versus detailed models, which may warrant further investigation.

Conclusions: Results of this study inform the selection of spatial buffering methods to estimate physical activity outcomes using an internationally consistent set of BEMs. Using three different network-based buffering methods, the findings indicate significant variation among BEM values, however associations with physical activity outcomes were similar across each buffering technique. The study advances knowledge by presenting consistently assessed relationships between three different network buffer types and utilitarian travel, sedentary behavior, and leisure-oriented physical activity outcomes.