A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement.

OBJECTIVES: The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no). DESIGN: We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider. RESULTS: All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups. CONCLUSIONS: The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.

To Make and Keep Friends: The Role of Health Status in Adolescent Network Tie Formation and Persistence.

Health status may shape network structure through network dynamics (tie formation and persistence) and direction (sent and received ties), net of typical network processes. We apply Separable Temporal Exponential Random Graph Models (STERGMs) to National Longitudinal Study of Adolescent to Adult Health survey data (n = 1,779) to differentiate how health status shapes network sent and received tie formation and persistence. Results indicate that networks are shaped by withdrawal of adolescents experiencing poor health, highlighting the importance of separating distinct and directed processes of friendship formation and persistence when considering how health relates to adolescent social life.

Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study.

OBJECTIVES: Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare. DESIGN: Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status. RESULTS: A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury. CONCLUSIONS: The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.

Revealing Hearing Loss: A Survey of How People Verbally Disclose Their Hearing Loss.

OBJECTIVE: Hearing loss is the most common sensory deficit and congenital anomaly, yet the decision-making processes involved in disclosing hearing loss have been little studied. To address this issue, we have explored the phrases that adults with hearing loss use to disclose their hearing loss. DESIGN: Since self-disclosure research has not focused on hearing loss-specific issues, we created a 15-question survey about verbally disclosing hearing loss. English speaking adults (>18 years old) with hearing loss of any etiology were recruited from otology clinics in a major referral hospital. Three hundred and thirty-seven participants completed the survey instrument. Participants' phrase(s) used to tell people they have hearing loss were compared across objective characteristics (age; sex; type, degree, and laterality of hearing loss; word recognition scores) and self-reported characteristics (degree of hearing loss; age of onset and years lived with hearing loss; use of technology; hearing handicap score). RESULTS: Participants' responses revealed three strategies to address hearing loss: Multipurpose disclosure (phrases that disclose hearing loss and provide information to facilitate communication), Basic disclosure (phrases that disclose hearing loss through the term, a label, or details about the condition), or nondisclosure (phrases that do not disclose hearing loss). Variables were compared between patients who used and who did not use each disclosure strategy using χ or Wilcoxon rank sum tests. Multipurpose disclosers were mostly female (p = 0.002); had experienced reactions of help, support, and accommodation after disclosing (p = 0.008); and had experienced reactions of being overly helpful after disclosing (p=0.039). Basic disclosers were predominantly male (p = 0.004); reported feeling somewhat more comfortable disclosing their hearing loss over time (p = 0.009); had not experienced reactions of being treated unfairly or discriminated against (p = 0.021); and were diagnosed with mixed hearing loss (p = 0.004). Nondisclosers tended not to disclose in a group setting (p = 0.002) and were diagnosed with bilateral hearing loss (p = 0.005). In addition, all of the variables were examined to build logistic regression models to predict the use of each disclosure strategy. CONCLUSIONS: Our results reveal three simple strategies for verbally addressing hearing loss that can be used in a variety of contexts. We recommend educating people with hearing loss about these strategies-this could improve the experience of disclosing hearing loss, and could educate society at large about how to interact with those who have a hearing loss.

Country Differences in Older Men's Hearing Difficulty Disadvantage.

Objectives: Hearing difficulty is prevalent in older adulthood and projected to increase via global aging, particularly among men. Currently, there is limited research on how this gender disparity might vary by country. Methods: Using 2018 data (n = 29,480) from the Health and Retirement Study (HRS) international family of studies, we investigate gender disparities in hearing difficulty among respondents ages 55-89 from the United States (n = 12,566), Mexico (n = 10,762), and Korea (n = 6152) with country-specific ordinal logistic regression models that progressively adjust for demographic, social, and health indicators. Results: In the United States, men's hearing difficulty disadvantage was consistently observed. In Mexico, men's hearing difficulty disadvantage was explained by the interactive effect of gender and age group but resurfaced after adjusting for comorbidities. In Korea, there was consistently no gender difference in hearing difficulty. Discussion: Our results highlight the heterogeneity in older men's hearing difficulty disadvantage among a diverse group of aging countries.

The impact of hearing loss on trajectories of depressive symptoms in married couples.

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

Association between perceived risk of Alzheimer's disease and related dementias and cognitive function among U.S. older adults.

INTRODUCTION: The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function. METHODS: We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0% probability), "unlikely" (1-49%), "uncertain" (50%), and "more than likely" (>50-100%). Additional baseline measures included participants' sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization. RESULTS: Of 1457 respondents (median age 74 [IQR = 69-80] and 59.8% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (ß = -2.10, P < 0.001) and "definitely not" (ß = -1.50, P < 0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status. CONCLUSIONS: Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals' perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.

Association Between Hearing Handicap and Life-Space Mobility in a Patient Population.

PURPOSE: The purpose of this study was to evaluate the association between self-reported hearing handicap and life-space mobility utilizing the Life-Space Questionnaire (LSQ). Life-space mobility reflects how an individual moves through their daily physical and social environment, and the role of hearing loss in life-space mobility is not fully understood. We hypothesized that those with higher self-reported hearing handicap would be more likely to demonstrate restricted life-space mobility. METHOD: A total of 189 older adults (M age = 75.76 years, SD = 5.81) completed a mail-in survey packet including the LSQ and Hearing Handicap Inventory for the Elderly (HHIE). Participants were categorized into one of three groups ("no/none," "mild/moderate," or "severe" hearing handicap) according to HHIE total score. LSQ responses were dichotomized to either "nonrestricted/typical" or "restricted" life-space mobility groups. Logistic regression models were performed to analyze life-space mobility differences among the groups. RESULTS: Logistic regression results demonstrated no statistically significant association between hearing handicap and LSQ. CONCLUSIONS: The results of this study indicate that there is no association between self-reported hearing handicap and life-space mobility as evaluated using a mail-in version of the LSQ. This counters other studies that have demonstrated that life space is associated with chronic illness, cognitive functioning, and social and health integration.

Corrigendum to "Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?" [SSM-Population Health 15 (2021) 100845].

[This corrects the article DOI: 10.1016/j.ssmph.2021.100845.].

The effect of 6 days of sodium phosphate supplementation on appetite, energy intake, and aerobic capacity in trained men and women.

Ingestion of an acute dose of phosphate has been shown to attenuate energy intake in the subsequent meal. This raises the question of whether the practice of phosphate supplementation over a number of days by athletes to enhance performance also influences energy intake. This study investigated the effect of 6 d of phosphate supplementation on appetite and energy intake, as well as aerobic capacity, in trained individuals. Twenty participants completed two 6-d phases of supplementation with either sodium phosphate (50 mg/kg of fat-free mass per day) or a placebo in a double-blinded, counterbalanced design. On Days 1, 2, and 6 of supplementation, a laboratory meal was provided to assess appetite and ad libitum energy intake. All other food and drink consumed during each supplementation phase were recorded in a food diary. After the 6 d of supplementation, peak aerobic capacity (VO(2peak)) was assessed. There was no difference in energy intake at the laboratory meal after an acute dose (i.e., on Day 1; placebo 2,471 ± 919 kJ, phosphate 2,353 ± 987 kJ; p = .385) or prolonged supplementation with sodium phosphate (p = .581) compared with placebo. Likewise, there was no difference in VO(2peak) with phosphate supplementation (placebo 52.6 ± 5.2 ml · kg(-1) · min(-1), phosphate 53.3 ± 6.1 ml · kg(-1) · min(-1); p = .483). In summary, 6 d of sodium phosphate supplementation does not appear to influence energy intake. Therefore, athletes supplementing with sodium phosphate can do so without hindering their nutritional status. However, given that phosphate supplementation failed to improve aerobic capacity, the ergogenic benefit of this supplement remains questionable.

The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life.

OBJECTIVES: We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood. METHODS: Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 (n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status. RESULTS: Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course. DISCUSSION: Findings suggest that childhood disability has long-term implications for life course mental health.

Self-reported hearing loss, hearing aid use, and cognitive function among U.S. older adults.

There has been increasing attention to the role of hearing loss as a potentially modifiable risk factor for Alzheimer's disease and related dementias. However, more nationally-representative studies are needed to understand the co-occurring changes in hearing loss and cognitive function in older adults over time, and how hearing aid use might influence this association. The purpose of this report is to examine how age-related changes in hearing loss and hearing aid use are associated with trajectories of cognitive function in a nationally-representative sample of U.S. older adults. We used 11 waves of longitudinal data from the Health and Retirement Study (HRS) from 1998 to 2018 to examine changes in self-reported hearing loss, hearing aid use, and cognitive function in adults 65 and older by race and ethnicity. Results from mixed models showed that greater levels of hearing loss were associated with lower levels of cognitive function at age 65 in non-Hispanic White, non-Hispanic Black, and Hispanic older adults. We also found that the associations diminished across age in White and Black individuals; but remained persistent in Hispanic individuals. The use of hearing aids was not associated with cognitive function in Black older adults but appeared protective for White and Hispanic older adults. Overall, the findings from this report suggest that the timely identification of hearing loss and subsequent acquisition of hearing aids may be important considerations for reducing declines in cognitive function that manifests differently in U.S. population subgroups.

Hearing Impairment and Mental Health Among Married Couples.

OBJECTIVES: Disablement is a significant health problem and chronic stressor for older adults and is associated with negative mental health outcomes. Although some research has explored how disability extends beyond individuals to influence the mental health of their support networks, less population-based research has assessed the consequences of hearing impairment, a growing public health concern that affects 72.4% of people aged 65 and older. Moreover, although much research has examined the negative individual impact of hearing impairment, less population-based research has assessed its consequences on spouses. To fill this gap, the current study builds on gender, marriage, and stress proliferation research to examine (a) the association between own hearing impairment and spouses' depressive symptoms, and (b) whether this association varies by the gender of the spouse. METHOD: Fixed-effects regression models were conducted using data from 5,485 couples (10,970 individuals) from 10 waves of the Health and Retirement Study (1998-2016). RESULTS: Wives' fair or poor hearing is significantly associated with an increase in husbands' depressive symptoms, net of controls. However, husbands' fair or poor hearing is not associated with an increase in wives' depressive symptoms. DISCUSSION: These findings suggest that hearing impairment can proliferate from one spouse to the other, but that this proliferation depends on gender. Health care providers need to be aware of the implications for husbands when treating women with hearing impairment.

Demographic and Socioeconomic Disparities in Life Expectancy With Hearing Impairment in the United States.

OBJECTIVES: Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. METHOD: We investigate the number of years an "average" person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n = 20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. RESULTS: Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. DISCUSSION: Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes.

Disaggregating Heterogeneity among Non-Hispanic Whites: Evidence and Implications for U.S. Racial/Ethnic Health Disparities.

Research has made strides in disaggregating health data among racial/ethnic minorities, but less is known about the extent of diversity among Whites. Using logistic regression modeling applied to data on respondents aged 40+ from the 2008 to 2016 American Community Survey, we disaggregated the non-Hispanic White population by ancestry and other racial/ethnic groups (non-Hispanic Black, non-Hispanic Asian, and Hispanic) by common subgroupings and examined heterogeneity in disability. Using logistic regression models predicting six health outcome measures, we compared the spread of coefficients for each of the large racial/ethnic groups and all subgroupings within these large categories. The results revealed that health disparities within the White population are almost as large as disparities within other racial groups. In fact, when Whites were disaggregated by ancestry, mean health appeared to be more varied among Whites than between Whites and members of other racial/ethnic groups in many cases. Compositional changes in the ancestry of Whites, particularly declines in Whites of western European ancestry and increases in Whites of eastern European and Middle Eastern ancestry, contribute to this diversity. Together, these findings challenge the oft-assumed notion that Whites are a homogeneous group and indicate that the aggregate White category obscures substantial intra-ethnic heterogeneity in health.

Overcrowding and COVID-19 mortality across U.S. counties: Are disparities growing over time?

A growing line of research underscores that sociodemographic factors may contribute to disparities in the impact of COVID-19. Further, stages of disease theory suggests that disparities may grow as the pandemic unfolds and more advantaged areas are better able to apply growing knowledge and mitigation strategies. In this paper, we focus on the role of county-level household overcrowding on disparities in COVID-19 mortality in U.S. counties. We examine this relationship across three theoretically important periods of the pandemic from April-October 2020, that mark both separate stages of community knowledge and national mortality levels. We find evidence that the percentage of overcrowded households is a stronger predictor of COVID-19 mortality during later periods of the pandemic. Moreover, despite a relationship between overcrowding and poverty at the county-level, overcrowding plays an independent role in predicting COVID-19 mortality. Our findings underscore that areas disadvantaged by overcrowding may be more vulnerable to the effects of COVID-19 and that this vulnerability may lead to changing disparities over time.

Immigration and health among non-Hispanic whites: The impact of arrival cohort and region of birth.

Immigration is central to our understanding of U.S. racial and ethnic health disparities, yet relatively little is known about the health of white immigrants - a group whose ethnic origins have become increasingly diverse. To the extent that whites are included in social stratification research, they are typically used as the reference category for gauging health inequities, with little attention to diversity among them. This study addresses this question using nationally representative data from the American Community Survey (2008-2017). We disaggregate non-Hispanic whites by nativity, region of birth, and period of arrival in the U.S. and examine differences in physical disability among adults aged 40 and older (n = 12, 075, 638). The analysis finds that foreign-born whites have a slightly lower prevalence of disability than U.S.-born whites, and this varies by arrival cohort. Immigrants who arrived in the 1981-1990 and 1991-2000 cohorts have a smaller advantage over U.S.-born whites than immigrants in the earlier and later cohorts. Compositional changes in the region of birth of white immigrants, especially the influx of eastern Europeans and Middle Easterners during the 1980s and 1990s, explained this variation. These findings challenge the oft-assumed notion that whites are a monolithic group and highlight growing intra-ethnic heterogeneity that is obscured by the aggregate category. Our findings also suggest that the standard practice of using whites as the reference for benchmarking health inequities may mask health inequities not only among them, but also between whites and other racial and ethnic populations.

Disparities in functional disability among Arab Americans by nativity, immigrant arrival cohort, and country of birth.

This study contributes to a growing literature that documents the importance of arrival cohort and country of birth for differentiating the health of U.S. immigrants. We use nationally-representative data from nine years of the American Community Survey (2008-2016) to examine if an immigrant health advantage exists among Arab Americans ages 40+ (n = 49,867) and test if differences among the foreign-born vary by arrival cohort (pre-1991, 1991-2000, and 2001+). Results from multivariate logistic regression models find that foreign-born Arab Americans have higher odds of physical and self-care disability, and this varies by immigrant arrival cohort. The post-2001 cohort had the highest odds of both disabilities, while the earlier two cohorts did not differ from the native-born after adjustments for covariates. Compositional differences in birthplace, particularly the large influx of immigrants from Iraq in the most recent cohort, explained these differences. Political instabilities globally have contributed to a growing number of U.S. immigrants with vulnerabilities that might be overlooked when arrival cohorts are not considered.

Preliminary Validation of the Exercise-Snacking Licensing Scale: Rewarding Exercise with Unhealthy Snack Foods and Drinks.

There is evidence that individuals' compensatory health beliefs may be an important psychological driver of health behavior. Only recently, however, have researchers begun to develop and seek to validate instruments that are suited to measuring specific pairings of the diverse compensatory health beliefs that exist. The aim of this study was to provide support for key aspects of validity associated with the Exercise-Snacking Licensing Scale (ESLS), an instrument that was designed to assess individuals' endorsement (or licensing) of unhealthy snacking behaviors around exercise. Participants (N = 1095) responded to a version of the ESLS that was designed to assess their licensing responses following either "light" or "tiring" physical activity, and completed additional instruments assessing dispositional, exercise-related, and diet-related constructs. Analyses indicated that scores derived from both versions of the ESLS ("light" and "tiring" physical activity) displayed a relatively consistent factor structure, favorable alpha coefficients, and meaningful correlations with variables that are theoretically aligned with licensing. Factor analytic procedures did, however, indicate that researchers may wish, in future, to consider the use (or not) of reverse-scored items within the ESLS. Together, these findings provide important insight into the structural, external, and generalizability aspects of validity for scores derived from the ESLS, and indicate that the ESLS may be a valuable instrument for the brief assessment of unhealthy licensing beliefs around exercise. Further use of the ESLS is encouraged to determine if and how these licensing beliefs actually influence subsequent snacking behaviors, and the potential downstream effects these beliefs may have in shaping health outcomes associated with exercise participation.

Testing the Feasibility and Preliminary Efficacy of an 8-Week Exercise and Compensatory Eating Intervention.

The aim of this study was to evaluate the feasibility and preliminary efficacy of an intervention comprised of regular exercise alongside educational and motivational support for participants' avoidance of unhealthy compensatory eating. Forty-five sedentary individuals were randomized to an 8-week exercise plus compensatory eating avoidance program (CEAP; n = 24), or an 8-week exercise intervention only (control; n = 21). The feasibility and preliminary efficacy of the intervention were assessed using quantitative measures and supplemented with written responses to open-ended questions. The CEAP workshop was well-received; however, self-reported use of some of the included behavior change strategies was lower than expected. Post-intervention, there was evidence of reduced self-reported compensatory eating for participants in the CEAP group but not controls, with CEAP participants also reporting greater use of coping plans relative to controls post-intervention. The exercise program had benefits for waist circumference, body fat percentage, blood pressure, and cardiovascular fitness; however, improvements were similar between groups. Taken together, the results of this study indicate that the CEAP is feasible and may reduce compensatory eating around exercise; however, this effect is small. Potential modifications to the CEAP are discussed within the paper.