Path Analysis of Campus Walkability/Bikeability and College Students' Physical Activity Attitudes, Behaviors, and Body Mass Index.

PURPOSE: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students' body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. DESIGN: Cross-sectional. SETTING: Thirteen university campuses. PARTICIPANTS: A total of 1384 student participants. MEASURES: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. ANALYSIS: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. RESULTS: The overall model fit was good with χ2 of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (ß = -.085) and positive association between personal barriers and BMI (ß = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (ß = .010). Self-regulation was positively associated with moderate-intensity PA (ß = .213), which, in turn, was negatively associated with BMI (ß = -.057). CONCLUSIONS: The ease of walking and biking on a campus was related to college students' walking behavior and their BMI. Students' PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Processes underlying young women's decisions to eat fruits and vegetables.

OBJECTIVE: To relate the use of identified processes that college women use to eat enough fruits and enough vegetables to their stages of readiness to change and their fruit and vegetable (F/V) intakes. METHOD: A cross-sectional assessment of college women 18-24 years of age (n = 236) was conducted to assess stage of readiness to eat F/V. Use of seven processes, earlier confirmed in a separate sample of college students the same age (health concerns, self-reevaluation, social liberation, health commitment/action, interpersonal control, external reinforcement and helping relationships) was compared with stage of change for F/V and 3 days of dietary intakes. RESULTS: In these young college women, use of self-reevaluation, a cognitive process for change, peaked in the preparation stage for both F/V. Use of health commitment/action, a post-action process including counter-conditioning, peaked in those in action/maintenance for F/V. Weight concerns related to the counter-conditioning processes women used to eat more fruit. CONCLUSION: Health practitioners should focus on weight management, appearance and health benefits of eating fruits and vegetables for this demographic group.

Healthy eating for rural low-income toddlers: caregivers' perceptions.

Caregivers exert a powerful influence on young children's eating habits. This qualitative study used focus groups to assess nutritional needs and barriers in establishing healthy eating habits in toddlers. Three focus groups were conducted with rural, low-income caregivers, 2 with men and 1 with women, in 3 rural Michigan counties. Four major themes emerged: (a) barriers to providing healthy meals, (b) division of responsibility, (c) mealtime behavior, and (d) desired nutrition education. The major barriers identified were work schedules; cost of food; inadequate time to shop, plan, and prepare nutritious meals; or a combination thereof. Caregivers expressed concern for the nutritional well-being of their toddlers. The perceived needs and perceptions of low-income caregivers need to be considered when providing nutrition education. Findings from this study provided the basis for developing a nutrition education intervention for low-income parents of young children.

Physical activity and stages of change in fifth and sixth graders.

The Stage of Change (SC) paradigm was adapted to assess readiness to be or stay physically active among fifth and sixth graders. Students completed a four-item SC survey, the Past Year Leisure Time Physical Activity Questionnaire, and the Modifiable Physical Activity Questionnaire for Adolescents. Precontemplation, contemplation, and preparation stages were grouped as "pre-action" (PRE), and action and maintenance as "post-action" (AX) stages. Nearly 40% of all students were in PRE, compared to 60% of students in AX stages. Twenty-two percent of all students were in the sedentary precontemplation or contemplation stages. Significantly more boys were in maintenance than girls, and more girls than boys were in contemplation. Students averaged 14-21 hours/week of television, video, or computer work, and 1.6 hours/week of physical activity outside of school. Interventions may be targeted at a specific SC to enable a child to move forward along the SC continuum toward an active lifestyle.

The effect of weight cycling on blood lipids and blood pressure in the Multiple Risk Factor Intervention Trial Special Intervention Group.

OBJECTIVE: To assess whether weight cycling has adverse effects on blood lipids or blood pressure. DESIGN: Cohort study, six years of follow-up, comparing net change in blood lipids and blood pressure among weight cyclers and non-cyclers. SUBJECTS: Men (n = 4353), age 35-57 y, at high risk for heart disease because of smoking, high blood pressure, and elevated cholesterol concentration in the Multiple Risk Factor Intervention Trial (MRFIT)--a 22-site, multi-center collaborative primary prevention trial conducted in the US, 1973-1983. MEASUREMENTS: A weight cycle was defined as loss and regain of at least 5% of mean weight. Outcome measures were changes from baseline to year six in total serum cholesterol, high density lipoprotein cholesterol (HDL), the ratio of total cholesterol to HDL, and diastolic blood pressure. ANALYSIS: Analysis of covariance models were developed, with number of weight cycles as the predictor variable. The hypothesis was that men who weight cycled would experience less improvement in blood lipids and blood pressure than those who did not cycle. Adjustments were made for net weight change and other factors affecting each outcome. RESULTS: Men who weight cycled did not have the predicted smaller improvements in total cholesterol, HDL, the ratio of total cholesterol to HDL, or diastolic blood pressure, compared with noncyclers. CONCLUSION: An adverse effect of weight cycling on blood pressure or blood lipids was not found. The excess mortality previously reported among weight cyclers in this population can probably not be attributed to effects on these CVD risk factors.

Dieting behavior of Asian college women attending a US university.

Dieting behavior, body dissatisfaction, self-esteem, and food intake of 73 Asian women attending a US university were investigated and compared retrospectively with attitudes of 247 US-born female students at the same university. The Asian women reported restrained eating and body dissatisfaction only about half as often as the US women did. In both the Asian and US college women, body dissatisfaction scores were significantly correlated to body mass index and self-esteem scores. Fourteen percent of the Asian women in the restrained eating/body dissatisfied group, and 40% of the US students in that group reported intentional vomiting for weight control. Some of the Asian international students practiced undesirable dieting behaviors and reported body dissatisfaction levels similar to those of many US college women. College health professionals should recognize that disordered eating among Asian women must not be overlooked because of stereotypical perceptions about Asian women's body size and type.

Among young adults, college students and graduates practiced more healthful habits and made more healthful food choices than did nonstudents.

OBJECTIVES: Health-related characteristics and habits and food choices of young adults were compared for three groups: college students, college graduates, and nonstudents. DESIGN: Subjects completed a mailed survey that included questions about demographics, attitudes, and behaviors and a food frequency questionnaire. Main outcome measures were health-related characteristics and habits and food choices. SUBJECTS: Female (n = 758) and male (n = 580) 18- to 24-year-olds in nine states who were selected randomly by zip code in each state. The response rate averaged 43% for all states. STATISTICAL ANALYSES PERFORMED: Analysis of variance of chi 2 tests were applied to health-related personal characteristic variables and the Kruskal-Wallis analysis of variance was applied to food consumption variables for women and men separately. RESULTS: According to self-reported heights and weights, female nonstudents were more often overweight than female students or graduates. Nonstudents of both genders reported smoking more often than students or graduates. College students and graduates ate more grain foods high in dietary fiber, more fruits and dark-green vegetables, and more lower-fat milk and meats than nonstudents. CONCLUSIONS/APPLICATIONS: Nonstudents were at greater health risk for some chronic illnesses, because of poorer health habits and food choices, than were college students and graduates. The behavior of nonstudents implies weaker response to messages promoting weight control, smoking cessation, and observance of the Dietary Guidelines for Americans than behavior exhibited by students or college graduates. Health promotion efforts could be enhanced by identifying demographic, educational, situational, and formative influences on positive health and dietary behaviors of young adults.

Operations for gastric ulcer: a long-term study.

This study assesses the long-term results of operations for benign gastric ulcers. Three-hundred forty-nine patients operated upon between 1950-1979 have been followed over the past 20 years with a mean and median follow-up of 11.8 and 11.1 years. Fifty-five per cent of the patients had a gastric resection without vagotomy; 19.8 per cent had gastric resection with vagotomy; and 20.3 per cent had vagotomy, pyloroplasty, and wedge excision or biopsy of the ulcer. Operations were selected based on the type of ulcer (Types 1-4), whether the surgeon suspected cancer preoperatively, whether the operations was elective or an emergency, and the age and general health of the patient (presence of significant co-morbid disease). Overall mortality was 6.9 per cent, with a mortality for elective operations 3.6 per cent, and for emergency operations of 32.5 per cent. Age and cardiovascular disease were significant factors in operative mortality and morbidity. All operations were equivalent in long-term results. Excellent to good results were obtained in 92 per cent of patients, with an ulcer recurrence rate of 4 per cent. We conclude that vagotomy, pyloroplasty, and wedge excision or biopsy of a benign gastric ulcer is a comparable operation to a more major gastric resection, with or without vagotomy, in the surgical management of gastric ulcer. The addition of vagotomy to gastric resection does not appear to improve long-term results.

Quantitative use of the Food Guide Pyramid to evaluate dietary intake of college students.

OBJECTIVES: To evaluate the usefulness of the Food Guide Pyramid as a quantitative tool for assessing nutritional adequacy and quality. DESIGN: One-day food records (n = 2,489) were assigned food group scores (1 through 5) by two systems. System 1 recorded the number of food groups on a given record that included the minimum number of servings suggested by the Food Guide Pyramid. System 2 recorded the number of food groups in the Food Guide Pyramid for which at least one serving was included. The food records were further evaluated by mean adequacy ratio (MAR) for iron, calcium, magnesium, vitamin A, and vitamin B-6 (MAR-5 score) and percentage of energy contributed by fat and sugar. Sensitivity and specificity of the food group scores to predict nutritional inadequacy were determined. SUBJECTS: College students (n = 2,489) attending introductory nutrition, foods, and health-related courses at a mid-western university. STATISTICAL ANALYSES: Student's t test, chi2 test, Dunnett's multiple mean comparison test. RESULTS: A food group score of 5 was given to 11% and 35% of the diet records by systems 1 and 2, respectively; MAR-5 scores of 75 or greater were given to 70% of the records. Only 4% of the diets contained both 30% or less and 10% or less of energy from fat and sugar, respectively. Both scoring systems can be used as a quantitative tool for screening nutritional inadequacy with high sensitivity (correctly classifying nutritionally inadequate diets) but with a moderate to low specificity (correctly classifying nutritionally adequate diets).

Relationship of diet, abdominal obesity, and physical activity to plasma lipoprotein levels in Asian Indian physicians residing in the United States.

OBJECTIVE: To examine the relationship of total fat, saturated fat, carbohydrate and energy intake, leisure-time activity, waist-to-hip ratio (WHR), and body mass index to the prevalence of atherogenic plasma triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels in Asian Indians living in the United States. High plasma TG and low HDL-C levels have been documented in Asian Indians worldwide. DESIGN: This exploratory study examined medical history, demographics, anthropometrics, plasma lipids levels, food intake frequency, and self-reported leisure-time activity. SUBJECTS: 153 Asian Indian male physicians (mean age=47 years) were recruited at two annual national conferences of the American Association of Physicians from India, with free medical assessments as incentives. STATISTICAL ANALYSES PERFORMED: Correlational and multiple regression analyses were performed. RESULTS: Subjects' diets averaged 56% energy from carbohydrate, 32% from total fat, and 8% from saturated fat. High total fat intake was associated with high WHR (r=.21, P<.01) and high total carbohydrate intake (grams per day) was associated with high TG level (r=.24, P<.05). Leisure-time activity averaged 136 minutes/week and negatively correlated with total plasma cholesterol level (r=.22, P<.01) and low-density lipoprotein cholesterol level (r=.25, P<.001). APPLICATIONS: Dietitians should recommend moderate dietary carbohydrate intake and meal patterns with energy distributed throughout the day, in addition to decreasing fat consumption, to Asian Indian clients at risk for coronary artery disease. High carbohydrate intake and uneven diurnal distribution (no breakfast and large evening meals) are associated with high TG and low HDL-C levels in this population.

Kindergarten students' food preferences are not consistent with their knowledge of the Dietary Guidelines.

OBJECTIVES: To evaluate kindergarten students' understanding of the concepts and terminology in the Dietary Guidelines for Americans; to determine whether kindergarteners could name food sources of fat, salt, and sugar; and to find out how well they understood the relationship between diet, exercise, body fat, and health. Additionally, food preference information was collected so that kindergarteners' knowledge about the Dietary Guidelines could be compared with their food choices. DESIGN AND SUBJECTS: Focus-group interviews were conducted in two elementary schools with 12 groups of about five students each (n = 62). Four classrooms were self-selected depending on the teacher's willingness to facilitate student participation; the sample was not random. RESULTS: Students understood the general relationship between food choices, exercise, body fat, and health. They were able to name foods high in salt, fat, and sugar and thought consumption of sugary or fatty foods should be limited. Nevertheless, their food preferences were not consistent with recommendations of the Dietary Guidelines to moderate foods high in these nutrients. APPLICATIONS: Nutrition educators should be aware that young children might not understand terms frequently used such as animal sources of foods or variety. Students know what to eat, but their practices are inconsistent with their knowledge. Providing information about what to do is not enough. To help students transfer factual information to personal dietary practices, nutrition educators need to teach them how to apply the Dietary Guidelines within their food environment while maintaining acceptability in regard to taste.

Nutrition education needs and learning preferences of Michigan students in grades 5, 8, and 11.

An assessment of nutrition education needs and learning preferences of students in grades 5, 8, and 11 was conducted to target instruction toward areas of highest need and strongest interest of students using teaching methods they prefer. This research evaluated students' knowledge, attitudes, and practices related to the Dietary Guidelines for Americans, including knowledge of the new Food Guide Pyramid; attitudes about school lunches and learning about nutrition; nutrition topics of interest; and preferred methods for learning about nutrition. Although results varied across grade level, generally students need to learn about the Food Guide Pyramid; the relationship between dietary fat, weight status, and health; and food sources of fat, salt, and fiber. They want to learn about personal health--how to control weight, improve diet, and prevent disease--using instructional methods that actively involve them. Results provide information relative to students' interest, understanding, and application of the Dietary Guidelines.

Key modifiable factors in weight maintenance: fat intake, exercise, and weight cycling.

OBJECTIVE: This 6- to 42-month follow-up study of a 6-month worksite weight control intervention examined predictors of weight maintenance, with a focus on those that could be modified. SUBJECTS: Twenty-nine participants, 14 men and 15 women, from a behavior modification program completed follow-up measurements. MAIN OUTCOME MEASURES: Height, weight, waist-to-hip ratio, food and beverage intake from a 3-day food record, weight history, social support and physical activity were the main outcome measures. RESULTS: One third of the participants maintained their weight losses within 2 kg at follow-up, although all had higher relative weights at follow-up than immediately after the program. High daily fat consumption (r = .40) and reduced time in physical activity (r = .34) correlated with increased relative weight at follow-up (P < .05). APPLICATION: Because previous weight cycling was so strongly related to weight loss maintenance (r = .55), potential weight program participants should learn and practice the weight maintenance behaviors of reduced dietary fat and regular exercise, independently of and before weight reduction attempts.

Can nutrition information increase sales of healthful vended snacks?

Snack selections from unrefrigerated vending machines were studied in relation to increasing availability of nutrient-dense snack options and providing nutrient information at four selected vending sites on a large university campus. Only four of 133 different snacks available for unrefrigerated vending met the criterion for nutrient-dense snacks. When snack proportion was changed to increase availability of nutrient-dense snacks, sales dropped. When nutrition information in bar graph form was posted on the machines, sales increased but not back to the original level. Although snack sales increased after graphic nutrition information was posted, sales were primarily for the least nutrient-dense, perhaps because few well-liked, nutrient-dense snacks were available for unrefrigerated vending. Schools concerned about providing a selection of vended snacks in agreement with the U.S. Dietary Guidelines might be advised to maintain refrigerated vending or to pursue a "healthy snack" machine concept.

Obesity, weight loss, and health.

Obesity is a multifactorial, complicated condition or group of conditions that afflicts a growing number of people in the United States. Precise etiologies are not well understood, and both commercial and medical treatment programs are characterized by high rates of recidivism. A cultural preoccupation with slimness has created a huge industry serving millions of people who are attempting continually to reduce weight. Contradictory messages from professionals have led to confusion concerning the health implications of obesity and the potential risks of repeated dieting. This review summarizes the major areas of consensus and controversy concerning the health implications of obesity and weight loss and suggests directions for treatment that take into account the complex causes and consequences of obesity.

Discrepancies among predictors of desirable weight for black and white obese adolescent girls.

Desirable weights were determined for 26 black and white, postmenarchal girls (11 to 15 years old) with juvenile-onset obesity. Each subject was measured for height, weight, triceps and subscapular fatfolds, and body density by underwater weighing (UWW). Body mass indexes and desirable weights were determined by UWW, from the US National Health Examination Survey (NHES) data, and from the Slaughter fatfold equation to estimate body fat. Desirable weights obtained from NHES growth charts were consistently lower than those obtained from UWW, especially for blacks (P less than .01). Findings from both the Slaughter fatfold equation and percent body fat from UWW indicated that growth charts provide lower-than-appropriate weight goals for both black and white obese girls. Results of our study suggest that health professionals should consider a measurement of body composition or at least increase desirable weights by 10% to 30% when setting weight recommendations from weight-for-height charts for obese adolescent girls.