Food hiding and weight control behaviors among ethnically diverse, overweight adolescents. Associations with parental food restriction, food monitoring, and dissatisfaction with adolescent body shape.

The present study aims to extend previous research conducted with children by examining associations between parental behaviors (food restriction, food monitoring) and parental perceptions (dissatisfaction with adolescent body shape) with adolescent behaviors (food hiding and weight control behaviors) among an ethnically diverse sample of overweight adolescents. Survey data were collected from overweight adolescents and their parents/guardians (n=116 dyads) at an urban Midwest adolescent health clinic. Adjusting for parent and adolescent demographic characteristics, logistic regression analyses revealed a significant positive association between parental food restriction and adolescent food hiding. No significant associations were found between dissatisfaction with adolescent body shape or parental food monitoring and adolescent food hiding and adolescent weight control behaviors when controlling for demographic factors. Interventions with parents of overweight adolescents should focus on helping parents talk with their adolescents about weight concerns in a non-judgmental way and teaching parents strategies to both create a healthful home food environment and guide and support their adolescents to lose weight in a healthful manner.

Comparison of body perceptions between obese primary care patients and physicians: implications for practice.

OBJECTIVE: To compare the body image and weight perceptions of primary care patients and their physicians as a first step toward identifying a potential tool to aid physician-patient communication. METHODS: Patients with a body mass index (BMI)> or =30 (n=456, 66% female) completed body image and weight status measures after office visits; physicians (n=29) rated the body figures and weight status of these same patients after office visits. RESULTS: Controlling for BMI, female patients and their physicians showed little or no difference in body figure selection or weight status classification, whereas male patients were significantly less likely than their physicians to self-identify with larger body figures (z=3.74, p<0.01) and to classify themselves as obese or very obese (z=4.83, p<0.0001). CONCLUSION: Findings reveal that physicians and female patients have generally concordant views of the patient's body size and weight status, whereas male patients perceive themselves to be smaller than do their physicians. The discrepancy between male patient and physician views is especially evident at increasingly larger body figure/weight status categories. PRACTICE IMPLICATIONS: When counseling male patients on weight loss, it could be helpful to assess body image and use this information to raise patient awareness of their size and to facilitate communication about weight.

Pathway to health: cluster-randomized trial to increase fruit and vegetable consumption among smokers in public housing.

OBJECTIVES: Examine the effectiveness of an intervention to increase fruits and vegetables (FV) consumption among smokers. DESIGN: Cluster-randomized trial of 20 public housing developments; 10 randomly assigned to an FV intervention and 10 to a smoking cessation intervention. MAIN OUTCOME MEASURES: Usual (past 7 days) and past 30 days change in daily FV intake at 8 weeks and 6 months postbaseline. RESULTS: Greater increases were seen in the FV group. At Week 8 and Month 6, the FV group had consumed 1.58 (p = .001) and 0.78 (p = .04), respectively, more daily FV servings in the past 7 days than the cessation group. At the same time points, the FV group had consumed 3.61 (p = .01) and 3.93 (p = .01), respectively, more FV servings in the past 30 days than the cessation group. Completing more motivational interviewing sessions (p = .02) and trying more recipes (p = .02) led to significantly greater increases at Month 6 among FV participants. CONCLUSIONS: Motivational interviewing counseling and lifestyle modification through trying out healthy recipes may be effective in helping a high-risk population increase their FV intake.

Baseline characteristics and recruitment strategies in a randomized clinical trial of African-American light smokers.

PURPOSE: This study describes the design, recruitment, and baseline data of the first smoking-cessation clinical trial for African-American light smokers, Kick It at Swope II (KIS-II). DESIGN: KIS-II was a randomized trial testing the efficacy of nicotine gum (vs. placebo gum) in combination with counseling (motivational interviewing or health education). SETTING: This study was conducted at an urban community-based clinic serving predominantly lower-income African-Americans. SUBJECTS: African-Americans who smoked 1 to 10 cigarettes per day were eligible. Of 1933 individuals screened, 1012 (52%) were eligible and 755 (75%) were enrolled in the study. MEASURES: Baseline assessment included smoking history and psychometric measures. ANALYSIS: The majority of participants were women (67%) with a mean age of 45.1 years (SD = 10.7). Participants smoked on average 7.6 cigarettes (SD = 3.21) per day, had a mean exhaled carbon monoxide level of 13.9 ppm (SD = 8.9) and a mean serum cotinine level of 244.2 ng/mL (SD = 154.4), and reported high levels of motivation and confidence to quit smoking. CONCLUSION: African-American light smokers were motivated to stop smoking and to enroll in a smoking-cessation program. Characteristics of our sample suggest African-American light smokers are an appropriate group for inclusion in smoking-cessation interventions.

Nicotine dependence among African American light smokers: a comparison of three scales.

Approximately 50% of African American (AA) smokers are light smokers (smoke

Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial.

OBJECTIVE: To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. METHODS: Baseline variables were analyzed as potential predictors from a 2 x 2 cessation trial in which participants were randomly assigned to 1 of 4 treatment groups: nicotine gum plus health education (HE) counseling, nicotine gum plus motivational interviewing (MI) counseling, placebo gum plus HE counseling, or placebo gum plus MI counseling. Chi-square tests, 2 sample t-tests, and multiple logistic regression analyses were used to identify predictors of cotinine (COT) verified abstinence at month 6. RESULTS: In the final regression model, HE rather than MI counseling (odds ratio [OR]=2.26%, 95% confidence interval [CI]=1.36 to 3.74), older age (OR=1.03%, 95% CI=1.01 to 1.06), and higher body mass index (OR=1.04%, 95% CI=1.01 to 1.07) significantly increased the likelihood of quitting, while female gender (OR=0.46%, 95% CI=0.28 to 0.76),

Weight-related perceptions among patients and physicians: how well do physicians judge patients' motivation to lose weight?

BACKGROUND: Prior studies suggest that patients and physicians have different perceptions and expectations surrounding weight; however, few studies have directly compared patients' and physicians' perspectives. OBJECTIVES: (1) To measure the extent to which obese patients and their physicians have discrepant weight-related perceptions, and (2) to explore patient and physician characteristics that may influence patient-physician discrepancy in motivation to lose weight. DESIGN AND PARTICIPANTS: Four hundred and fifty-six obese patients (302 females; mean age = 55.1 years; mean BMI = 37.9) and their 28 primary care physicians (22 males, mean age = 44.1 years) from nonmetropolitan practices completed an anonymous survey after an office visit. MEASURES: Weight-related perceptions included perceived weight status, health impact of weight, 1-year weight loss expectations, and motivation to lose weight. Correlates included patient and physician sex, age, and BMI; physicians' reported frequency, perceived patient preference, and confidence for weight counseling; and practice characteristics (e.g., years in practice). RESULTS: Physicians assigned patients to heavier descriptive weight categories and reported a worse health impact than patients perceived for themselves, whereas patients believed they could lose more weight and reported a higher motivation to lose weight than their physicians perceived for patients (P < .001). Physicians who believed patients preferred to discuss weight more often (P = .001) and who saw more patients per week (P = .04) were less likely to underestimate patient motivation. CONCLUSIONS: Patients reported more optimistic weight-related perceptions and expectations than their physicians. Further research is needed to determine how these patient-physician discrepancies may influence weight loss counseling in primary care.

The effects of nicotine gum and counseling among African American light smokers: a 2 x 2 factorial design.

AIM: Approximately 50% of African American smokers are light smokers (smoke < or = 10 cigarettes a day). The prevalence of light smoking in the United States is increasing, yet there has not been a single smoking cessation clinical trial targeting light smokers. The purpose of this 2 x 2 factorial, randomized clinical trial was to evaluate the efficacy of nicotine gum (2 mg versus placebo) and counseling (motivational interviewing versus health education) for African American light smokers. DESIGN: Participants were assigned randomly to one of four study arms: 2 mg nicotine gum plus health education (HE); 2 mg nicotine gum plus motivational interviewing (MI); placebo gum plus HE; and placebo gum plus MI. PARTICIPANTS AND SETTING: A total of 755 African American light smokers (66% female, mean age = 45) were enrolled at a community health center over a 16-month period. INTERVENTION AND MEASUREMENTS: Participants received an 8-week supply of nicotine gum and six counseling sessions during the course of the 26-week study. Biochemical measures included expired carbon monoxide (CO) and serum and salivary cotinine. FINDINGS: Seven-day quit rates for nicotine gum were no better than for the placebo group (14.2% versus 11.1%, P = 0.232) at 6 months. However, a counseling effect emerged, with HE performing significantly better than MI (16.7% versus 8.5%, P < 0.001). These results were consistent across outcome time-points (weeks 1, 8, and 26). CONCLUSIONS: Results highlight the potential positive impact of directive information and advice-oriented counseling on smoking cessation. Studies are needed to assess other interventions that may further improve quit rates among African American light smokers who are motivated to quit.

Fruit, vegetable, and fat intake among non-Hispanic black and non-Hispanic white adolescents: associations with home availability and food consumption settings.

OBJECTIVE: This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents. PARTICIPANTS AND DESIGN: Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods. MAIN OUTCOMES: Correlates of fruit, vegetable, and fat consumption. STATISTICAL ANALYSIS: Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents. RESULTS: In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake. CONCLUSIONS: Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.

Leptin as a marker of body fat and hyperinsulinemia in college students.

Little is known about obesity and insulin resistance in college students. Leptin is a hormone secreted by fat cells and has been shown to strongly correlate with both obesity and insulin resistance in children and adults. We investigated associations of leptin with insulin secretion and action in 119 normal-weight students aged 18-24 years. Leptin was strongly correlated with total fat mass (r = .67, p <.001), percentage body fat (r= .81, p < .001), and to a lesser degree Body Mass Index, or BMI, (r = .23, p < .02). Leptin was associated with fasting insulin (beta+/-SE = 0.30+/-0.06, p < .001) and insulin resistance (beta+/-SE = 0.41+/-0.20, p < .001) independent of total fat, gender, and age, suggesting other mechanisms of leptin and insulin regulation besides obesity. Leptin resistance is present even among young and normal-weight college students. Leptin, even more so than BMI, is an important marker of adiposity and hyperinsulinemia in normal-weight college students and may potentially be used to predict type 2 diabetes.

Factors associated with BMI, weight perceptions and trying to lose weight in African-American smokers.

This study examined sociodemographic, behavioral and psychosocial factors associated with BMI, weight perceptions and trying to lose weight among African-American smokers (N=600, M=44.2 years, 70% female). Sixty-eight percent of the sample were overweight or obese (sample BMI M=28.0, SD=6.7). Three separate, simultaneous multivariable regression models were used to determine which factors were associated with BMI, weight perceptions and trying to lose weight. Poorer health, female gender and high-school education or higher were significantly associated with higher BMIs (p<0.05). Being female (OR=5.8, 95% CI=3.6-9.3) and having a higher BMI (OR=0.6, 95% CI=0.5-0.6) was associated with perception of overweight and smoking more cigarettes per day (OR=1.0, 95% CI=1.0-1.1), and perceiving oneself as overweight (OR=14.1, 95% CI=8.2-24.2) was associated with trying to lose weight. Participants somewhat underestimated their BMI in their weight perceptions. Those who perceived themselves as overweight were more likely to be trying to lose weight; therefore, increasing participant awareness of actual BMI status may lead to improved weight-control efforts in African-American smokers. Several expected associations with outcomes were not found, suggesting that BMI and weight constructs are not well-understood in this population.

Predicting adoption of home smoking restriction by inner-city black smokers.

OBJECTIVE: To identify predictors of future adoption of home smoking restriction (HSR), given that 40% of inner-city smokers report current HSR. DESIGN: Secondary analysis of data on smokers enrolled in a double-blind, placebo-controlled, randomized trial of bupropion hydrochloride for smoking cessation. SETTING: Community health center in Kansas City, Kan, from August 1, 2000, to December 31, 2001. PARTICIPANTS: Six hundred eligible black smokers, at least 18 years old, who smoked at least 10 cigarettes per day and were interested in quitting within the next 30 days. Enrollment was limited to 1 smoker per household. MAIN OUTCOME MEASURES: Adoption of HSR by 6 months by those who did not have it at baseline. Result Baseline HSR was reported by 36% of all smokers. Of 383 smokers without baseline HSR, 311 smokers had complete baseline and 6-month data. Thirty-seven percent of households without HSR at baseline had adopted HSR by 6 months. Adoption was associated with a nonsmoking adult or children in the home, progress in stage of change, and smoking cessation. Odds of adopting HSR increased with progress in stage of change (odds ratio [OR], 4.20), baseline preparatory stage of change (OR, 3.28), and having a nonsmoking partner (OR, 2.35) or children (OR, 1.75) in the home. CONCLUSIONS: A smoker's motivation to quit and the presence in the home of a nonsmoking adult or of children predict adoption of HSR by inner-city black smokers. Therefore, health professionals should motivate the smoker toward HSR and the nonsmoking partner toward advocating home smoking bans, thereby eliminating environmental tobacco smoke in the home.

Childhood overweight: an expanding problem.

Childhood overweight is a significant and growing health problem in the US and other parts of the world. Secular trend data in the US suggest that children have become substantially heavier over the last several decades and that their risk for a number of health problems is increasing as a result. Defining obesity in children has been difficult as assessing body fat is expensive and impractical. Body mass index (BMI), derived from weight and height, is used as a surrogate indicator in adults. In children, the consensus is to use BMI percentiles statistically derived from a reference population. There is evidence that the prenatal, early childhood, and adolescent periods are critical in the development of obesity but the mechanisms involved are yet to be elucidated. The recent rapid increase in childhood overweight and obesity is attributed to the modern obesogenic environment. Changes in dietary constituents including higher derivation of energy from nutritionally poor and energy dense foods, increased sweetened drink consumption, larger portion sizes, and more frequent intake of food outside the home have been associated with poorer diets and higher weights. Further, physical activity has reduced with decreases in school physical education classes and organized sports, fewer opportunities to expend energy for daily living activity due to more mechanization, lower frequency of walking and biking, and greater use of sedentary activities for leisure. Television watching remains the most common activity for children. There are significant health outcomes associated with childhood obesity, including the presence of cardiovascular risk factors, and greater prevalence of various medical problems including insulin resistance, type 2 diabetes mellitus, the metabolic syndrome, orthopedic problems, and pseudotumor cerebri. Of further concern is the increased risk for obesity in adulthood with its attendant co-morbidities. Interventions are imperative but not widely studied. The most effective interventions include comprehensive behavioral management, dietary modification, and exercise. Family-based interventions have been most successful at maintaining long-term weight loss. School-based interventions have the potential to significantly impact childhood overweight as large numbers of children can be reached. However, such programs require long-term follow-up and are expensive. Very low calorie diets, pharmacotherapy, and surgery remain experimental options for children. More recently, metformin has shown promise in promoting weight loss and improving insulin sensitivity among adolescents. Combining multiple approaches for treatment, addressing obesity-promoting sociocultural practices and policies, and focusing on prevention strategies will be necessary to address this epidemic.

Comparison of smoking relapse curves among African-American smokers.

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.

Assessing overweight, obesity, diet, and physical activity in college students.

The authors surveyed 738 college students aged 18 to 27 years to assess overweight, obesity, dietary habits, and physical activity. They used BMI (body mass index) > or = 25 kg/m2 or BMI > or = 85th percentile and BMI > or = 30 kg/m2 or BMI > or = 95th percentile to estimate overweight and obesity in those aged < or = 19 years. To define overweight and obesity in those > or = 20 years, they used BMI > or = 25 kg/m2 and > or = 30 kg/m2. They found overweight rates of 21.6% using BMI directly and 16.2% using BMI percentile and obesity rates of 4.9% using BMI directly and 4.2% using BMI percentile. More than 69% of the participants reported < 5 servings of fruits and vegetables per day and more than 67% reported < 20 g of fiber per day; participants reported physical activity on fewer than 3 d/wk. Most college students are not meeting dietary and physical activity guidelines, suggesting the need for prevention interventions and increased understanding of overweight in college students.

The roles of parenting, church attendance, and depression in adolescent smoking.

The aim of the present study was to identify contextual factors related to smoking among urban African-American and White adolescents. We administered a survey assessing demographic and psychosocial variables to 299 adolescents in an urban pediatric clinic in the Midwest. Results indicated that being female, older age, lower academic performance, depressive symptoms, less frequent church attendance, parental smoking, and parental attitudes toward smoking were related to adolescent smoking. After controlling for demographics, the multivariate model predicting adolescent smoking included depressive symptoms, less frequent church attendance, and parental disapproval of smoking. Given these findings, efforts to decrease adolescent smoking may be enhanced by attending to depressive symptoms demonstrated by adolescents as well as contextual factors including parental attitudes and church attendance.

BMI percentiles and body image discrepancy in black and white adolescents.

The purpose of this study was to investigate the relationship between body image discrepancy (BID) and weight status as measured by BMI percentiles (BMI%) among adolescents. A cross-sectional survey was conducted among 265 adolescents at an urban clinic (females: 116 blacks and 63 whites; males: 62 blacks and 24 whites). BID was the difference between ideal and current body images selected from a 13-figure rating scale, and BMI% were calculated from measured weight and height. Regression analyses were conducted separately for girls and boys. Over half of the female and one-third of male adolescents wanted a thinner body. BID was positively related to BMI% with a one-unit increase in BID associated with a 4.84-unit increase in BMI% among females and a 3.88-unit increase in BMI% in males. Both female and male adolescents reported BID beginning at a BMI% corresponding to a normal weight. At zero BID, white females had a BMI% of 62.6, statistically different from black females (BMI% 69.7). At zero BID, white males had a mean BMI% of 69 and black males at a BMI% of 75.8, not statistically different. While black and white differences exist in BID, black female adolescents like their white counterparts are reporting BID at a weight range that is within the "normal". Our study portends the increase in BID with the increasing prevalence of obesity and highlights the need for interventions to help adolescents develop a healthy and realistic body image and healthy ways to manage their weight.

Demographic and psychosocial factors associated with increased fruit and vegetable consumption among smokers in public housing enrolled in a randomized trial.

OBJECTIVES: To examine the demographic and psychosocial factors associated with increased fruit and vegetable (FV) consumption among smokers residing in public housing. DESIGN: Cluster randomized trial of 20 public housing developments (HDs). Ten housing developments were randomly assigned to a FV intervention and 10 to a smoking cessation intervention. PRIMARY OUTCOME: Change in daily FV intake over the past 7 days at 8 weeks postbaseline. RESULTS: Above the effect of treatment, baseline confidence for vegetable consumption (model coefficient = 0.19, SE = 0.07, p = .01), decreased barriers (model coefficient = -0.12, SE = 0.04, p = .002) and increased agency (model coefficient = 0.08, SE = 0.04, p = .03) were significantly associated with week 8 FV consumption. CONCLUSIONS: Although the intervention produced significant change in FV consumption, the majority of individual psychosocial factors were not associated with this change. Future studies examining the dynamic interaction between interventions and individual, social, and environmental factors are needed to more fully explain dietary change among public housing residents.

Correlates of exercise participation in adolescents.

OBJECTIVE: The purpose of this analysis was to determine correlates of exercise participation among adolescents. DESIGN: A secondary analysis was conducted of data from a cross-sectional survey of 300 adolescents seen at an urban clinic. Using descriptive statistics and path analysis, we examined the direct and indirect effects of independent variables on exercise participation. RESULTS: Independent variables accounted for 15% of variance in exercise participation. In gender-stratified models, independent variables explained 18% of the variance for females. Older females were associated with lower exercise participation scores (beta=-.273, p<.001). Adolescent females who reported a strong relationship with parent(s) reported higher exercise participation scores (beta=.146, p<.05). Females with higher perception of environmental opportunities for exercise were associated with higher exercise participation (beta=.180, p<.05). Depressive symptoms had the strongest indirect effect (beta=-.10) on exercise participation via behavior-specific cognitions/affect factors among females. CONCLUSION: The results support that interventions to increase exercise should focus on older female adolescents. Providing information about environmental opportunities for exercise, enhancing relationship with parents, and intervening with adolescents at risk for depression might improve exercise rates in female adolescents.