Identifying the behavior change techniques used in obesity interventions: An example from the EARLY trials.

Objective: The dissemination of effective obesity interventions requires the documentation of key elements of the intervention. But outcome papers and other published manuscripts often lack detail that allow the replication of the intervention. The Behavior Change Technique (BCT) Taxonomy (BCTTv1) is a widely used approach to identify key elements of an intervention study. This study compares the extent to which BCTs and domains identified in studies' intervention protocol are concordant with detail from corresponding intervention design and study outcome papers. Methods: Data come from four obesity interventions with complete intervention protocols as well as published intervention design and outcome papers. The number of domains and BCTs was calculated for each treatment arm and stratified by coding source. Emphasis of domains and BCTs was determined using an Analytical Hierarchy Process (AHP). Results: A review of each study's intervention protocol showed the mean number of domains and BCTs used in treatment arms as 11.8 and 26.7, respectively. Primary outcome papers had a mean loss of 34% of the reported domains and 43% of BCTS as compared with intervention protocl. Design papers showed a loss of 11% and 21% of domains and BCTs, respectively. Conclusions: The results confirm the limitations of using the BCTTv1 coding of outcome papers to describe obesity-related interventions. The results also highlight the need for mechanisms that allow for a full description of intervention content such as inclusion in a supplemental section of an online journal or the use of intervention-focused consort guidelines.

The role of stress responses on engagement in dietary and physical activity behaviors among Latino adults living with prediabetes.

OBJECTIVES: Latinos are at a high risk of developing type 2 diabetes (T2D). Prediabetes is a major risk factor for T2D; however, progression to T2D can be slowed with engagement in healthy behaviors. Stress can hinder engagement with health behaviors. Qualitative methods were used to understand how Latinos with prediabetes attempted to modify their diet and physical activity behaviors to slow T2D progression and how stress affected their engagement in these behaviors. DESIGN: Semi-structured interviews were conducted with 20 Latinos with prediabetes in North Carolina. Participants were asked questions about types of stress they experienced and how stress affected their health. We generated codes on stress and stress responses and used content analysis to organize codes between and within participants. RESULTS: Behaviors changed after prediabetes diagnosis. Few participants reported changing their physical activity, however, all participants attempted to change their eating patterns by changing food types consumed and reducing portion sizes. The stress participants experienced impacted their ability to self-regulate their diet. They reported overeating or appetite suppression during stressful periods. Stress also affected cognitive responses by compromising healthy decision-making and instigating negative emotional reactions. Overall, stress complicated participants' ability to properly engage in recommended behaviors by negatively impacting participants' behavioral self-regulation and cognitive processes. CONCLUSIONS: Stress affects behavioral and cognitive progresses that adversely alters primarily dietary behaviors. Tailored plans acknowledging the impact of stress and providing coping and supportive help for dealing with stress may enhance engagement in healthy behaviors for Latinos with prediabetes.

Cooking Matters for Kids Improves Attitudes and Self-Efficacy Related to Healthy Eating and Cooking.

OBJECTIVE: To assess changes in self-efficacy and attitudes related to healthy eating and cooking in Cooking Matters for Kids participants. DESIGN: Prepost study design. SETTING: Cooking Matters for Kids programs offered by 35 organizations. PARTICIPANTS: Predominantly third- to fifth-grade children participating in Cooking Matters for Kids lessons during fiscal years 2012-17 with matched presurvey and postsurveys (n = 18,113). INTERVENTION(S): Cooking Matters for Kids consists of six 2-hour experiential nutrition and cooking education lessons. MAIN OUTCOME MEASURE(S): Self-efficacy related to healthy eating and cooking and attitudes toward healthy foods assessed through the Cooking Matters for Kids Participant Survey. ANALYSIS: Changes from the presurvey to postsurvey were assessed using mixed models and repeated measures ordered logistic regression accounting for clustering by course. Effect sizes were calculated using Cohen d for repeated measures. A Bonferroni adjustment was used to correct for multiple comparisons (α = 0.025). RESULTS: Both overall and individual self-efficacy and attitude scores improved from presurvey to postsurvey (P < 0.0001). The effect sizes were 0.35 for overall self-efficacy score and 0.17 for overall attitude score. CONCLUSIONS AND IMPLICATIONS: Participation in Cooking Matters for Kids was associated with improvements in self-efficacy and attitudes related to healthy eating and cooking.

College student motivations for and perceived impacts of volunteering with a nutrition and cooking education program for children.

To assess among college students their motivations for and perceived impacts of volunteering with Cooking Matters for Kids as part of No Kid Hungry NC. Seventeen college student volunteers responded to an online survey questionnaire assessing their motivations for volunteering and how they were impacted by their experiences. Motivational functions for volunteering (values, understanding, social, career, protective, enhancement) were assessed using the Volunteer Functions Inventory. The strongest motivational functions for volunteering were values and understanding. Students were also strongly motivated to volunteer related to the areas specifically addressed by the program (i.e., nutrition, public health, working with children). Perceived impacts of volunteering included being more comfortable working with children, improving knowledge/skills, gaining experience related to their future career, and having fun. Volunteering with Cooking Matters for Kids benefited college students. Issues addressed by the program and the desire to gain experience motivated students to volunteer.

All of That Causes Me Stress: An Exploration of the Sources of Stress Experienced by Latinxs Living with Prediabetes.

Latinxs immigrants in the United States experience sources of stress (i.e., stressors) that can limit their ability to engage in healthy behaviors. Stress has been linked to increased type 2 diabetes (T2D) risk in Latinxs living with prediabetes, a group disproportionately affected by T2D. The purpose of this qualitative study is to describe and contextualize the variety of stressors experienced by Latinxs immigrants diagnosed with prediabetes. Semi-structured, in-depth interviews were conducted from March to September 2018 with 20 Latinx immigrants living with prediabetes in North Carolina. We used qualitative content analysis including systematic coding and comparative matrices. The most prominent stressors were those related to health status and healthcare access, finances, interpersonal relationships with family, and loneliness. Participants also identified stressors related to documentation status and discrimination. The stressors Latinx immigrants with prediabetes experience vary, therefore studies and interventions need to specify which sources of stress they are addressing. Multilevel interventions that ameliorate the effects of stressors may facilitate preventive health behaviors among Latinxs with prediabetes.

Los inmigrantes latinxs radicados en los Estados Unidos experimentan fuentes estresantes (es decir., estresores) que pueden limitar su capacidad para participar en comportamientos saludables. El estrés es un mayor riesgo para el desarrollo de la diabetes tipo 2 (diabetes), particularmente para los latinxs que viven con prediabetes, un grupo desproporcionadamente afectados por la diabetes. El propósito de este estudio cualitativo es contextualizar la variedad de estresores que latinos diagnosticados con prediabetes experimentan. Entre marzo y septiembre del 2018 se llevaron a cabo entrevistas semiestructuradas en profundidad con 20 inmigrantes latinxs que viven con prediabetes en Carolina del Norte. Utilizamos análisis de contenido cualitativo que incluye codificación sistemática y matrices comparativas para crear temas analíticos. Los principales estresores fueron los relacionados con el estado de salud y el acceso limitado a la atención médica, las finanzas, las relaciones interpersonales con la familia y la soledad. Los participantes también expresaron dificultades para navegar en su entorno debido al estado de la documentación y la discriminación. Las intervenciones multinivel que mejoran los efectos de estresores pueden facilitar comportamientos preventivos de salud entre los latinxs con prediabetes.

Is late bedtime an overlooked sleep behaviour? Investigating associations between sleep timing, sleep duration and eating behaviours in adolescence and adulthood.

OBJECTIVE: To examine whether bedtime is associated with usual sleep duration and eating behaviour among adolescents, emerging adults and young adults. DESIGN: Cross-sectional multivariable regression models, stratified by developmental stage, to examine: (1) association between bedtime and sleep duration and (2) associations between bedtime and specific eating behaviours at each developmental period, controlling for sleep duration. All models adjusted for sociodemographic characteristics, depressive symptoms and screen time behaviours. SETTING: National Longitudinal Study of Adolescent to Adult Health, waves I-IV, USA. PARTICIPANTS: A national probability sample surveyed in adolescence (aged 12-18 years, wave I: 1994-1995, n 13 048 and wave II: 1996, n 9438), emerging adulthood (aged 18-24 years, wave III: 2001-2002, n 9424) and young adulthood (aged 24-34 years, wave IV: 2008, n 10 410). RESULTS: Later bedtime was associated with shorter sleep duration in all developmental stages, such that a 1-h delay in bedtime was associated with 14-33 fewer minutes of sleep per night (Ps < 0·001). Later bedtime was also associated with lower odds of consuming healthier foods (i.e. fruits, vegetables; range of adjusted OR (AOR), 0·82-0·93, Ps < 0·05) and higher odds of consuming less healthy foods and beverages (i.e. soda, pizza, desserts and sweets; range of AOR, 1·07-1·09, Ps < 0·05). Later bedtime was also associated with more frequent fast-food consumption and higher sugar-sweetened beverage consumption (Ps < 0·05). CONCLUSIONS: Later bedtime was associated with shorter sleep duration and less healthy eating behaviours. Bedtime may be a novel behaviour to address in interventions aiming to improve sleep duration and dietary intake.

Sleep duration and body mass: direction of the associations from adolescence to young adulthood.

Research suggests that sleep duration and obesity are related, but the direction of this association remains uncertain. We applied autoregressive cross-lag models to evaluate the directionality of the relationship between sleep duration and BMI from adolescence through emerging and young adulthood, life stages where the risk for developing obesity are particularly high. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined sex-stratified associations between sleep duration and BMI in this cohort from adolescence (ages 12-18, year 1996), to emerging adulthood (ages 18-24, 2001-2002), to young adulthood (ages 24-32, 2008), controlling for key confounders. For both males and females, higher BMI during an earlier developmental stage was associated with shorter sleep duration in the subsequent stage (both Bs = -0.02, ps < 0.01). However, sleep duration at an earlier developmental stage was not associated with BMI at the subsequent stage. Findings suggest that researchers should be cautious when interpreting cross-sectional relationships between sleep and BMI, as higher BMI may precede shorter sleep during adolescence to young adulthood. Researchers may also wish to account for potential bi-directional associations when modeling sleep and BMI using longitudinal data.

State-Level Point-of-Sale Tobacco News Coverage and Policy Progression Over a 2-Year Period.

BACKGROUND: Mass media content may play an important role in policy change. However, the empirical relationship between media advocacy efforts and tobacco control policy success has rarely been studied. We examined the extent to which newspaper content characteristics (volume, slant, frame, source, use of evidence, and degree of localization) that have been identified as important in past descriptive studies were associated with policy progression over a 2-year period in the context of point-of-sale (POS) tobacco control. METHOD: We used regression analyses to test the relationships between newspaper content and policy progression from 2012 to 2014. The dependent variable was the level of implementation of state-level POS tobacco control policies at Time 2. Independent variables were newspaper article characteristics (volume, slant, frame, source, use of evidence, and degree of localization) and were collected via content analysis of the articles. State-level policy environment contextual variables were examined as confounders. RESULTS: Positive, significant bivariate relationships exist between characteristics of news content (e.g., high overall volume, public health source present, local quote and local angle present, and pro-tobacco control slant present) and Time 2 POS score. However, in a multivariate model controlling for other factors, significant relationships did not hold. DISCUSSION: Newspaper coverage can be a marker of POS policy progression. Whether media can influence policy implementation remains an important question. Future work should continue to tease out and confirm the unique characteristics of media content that are most associated with subsequent policy progression, in order to inform media advocacy efforts.

Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Behavioral Domain.

BACKGROUND: The ability to identify and measure behaviors that are related to weight loss and the prevention of weight regain is crucial to understanding the variability in response to obesity treatment and the development of tailored treatments. OBJECTIVES: The overarching goal of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project is to provide obesity researchers with guidance on a set of constructs and measures that are related to weight control and that span and integrate obesity-related behavioral, biological, environmental, and psychosocial domains. This article describes how the behavioral domain subgroup identified the initial list of high-priority constructs and measures to be included, and it describes practical considerations for assessing the following four behavioral areas: eating, activity, sleep, and self-monitoring of weight. Challenges and considerations for advancing the science related to weight loss and maintenance behaviors are also discussed. SIGNIFICANCE: Assessing a set of core behavioral measures in combination with those from other ADOPT domains is critical to improve our understanding of individual variability in response to adult obesity treatment. The selection of behavioral measures is based on the current science, although there continues to be much work needed in this field.

Measures of the food environment: A systematic review of the field, 2007-2015.

BACKGROUND: Many studies have examined the relationship between the food environment and health-related outcomes, but fewer consider the integrity of measures used to assess the food environment. The present review builds on and makes comparisons with a previous review examining food environment measures and expands the previous review to include a more in depth examination of reliability and validity of measures and study designs employed. METHODS: We conducted a systematic review of studies measuring the food environment published between 2007 and 2015. We identified these articles through: PubMed, Embase, Web of Science, PsycINFO, and Global Health databases; tables of contents of relevant journals; and the National Cancer Institute's Measures of the Food Environment website. This search yielded 11,928 citations. We retained and abstracted data from 432 studies. RESULTS: The most common methodology used to study the food environment was geographic analysis (65% of articles) and the domination of this methodology has persisted since the last review. Only 25.9% of studies in this review reported the reliability of measures and 28.2% reported validity, but this was an improvement as compared to the earlier review. Very few of the studies reported construct validity. Studies reporting measures of the school or worksite environment have decreased since the previous review. Only 13.9% of the studies used a longitudinal design. CONCLUSIONS: To strengthen research examining the relationship between the food environment and population health, there is a need for robust and psychometrically-sound measures and more sophisticated study designs.

Multilevel analysis exploring the links between stress, depression, and sleep problems among two-year college students.

OBJECTIVE: This study explored the association of stress and depression with a multidimensional sleep problems construct in a sample of 2-year college students. PARTICIPANTS: The sample consisted of 440 students enrolled in 2-year study from Fall 2011 to Fall 2013. METHODS: Participants in an obesity prevention study completed surveys assessing sleep, stress, and depression at baseline, 4, 12, and 24 months. Multilevel models predicting sleep problems were conducted to distinguish episodic from chronic reports of stress and depression. RESULTS: Participants were primarily women (68%), white (73%), young adults (M age = 22.8), with an average of 8.4 hours of sleep per night. Neither stress nor depression was predictive of sleep quantity; however, they were predictive of sleep quality. CONCLUSIONS: Results show that sleep quality rather than sleep quantity may be the greater health concern for young adults, suggesting that intervention programs targeting depression, stress management, and healthy sleep patterns are warranted.

Setting the agenda for a healthy retail environment: content analysis of US newspaper coverage of tobacco control policies affecting the point of sale, 2007-2014.

BACKGROUND: Tobacco control policies affecting the point of sale (POS) are an emerging intervention, yet POS-related news media content has not been studied. PURPOSE: We describe news coverage of POS tobacco control efforts and assess relationships between article characteristics, including policy domains, frames, sources, localisation and evidence present, and slant towards tobacco control efforts. METHODS: High circulation state (n=268) and national (n=5) newspapers comprised the sampling frame. We retrieved 917 relevant POS-focused articles in newspapers from 1 January 2007 to 31 December 2014. 5 raters screened and coded articles, 10% of articles were double coded, and mean inter-rater reliability (IRR) was 0.74. RESULTS: POS coverage emphasised tobacco retailer licensing (49.1% of articles) and the most common frame present was regulation (71.3%). Government officials (52.3%), followed by tobacco retailers (39.6%), were the most frequent sources. Half of articles (51.3%) had a mixed, neutral or antitobacco control slant. Articles presenting a health frame, a greater number of protobacco control sources, and statistical evidence were significantly more likely to also have a protobacco control slant. Articles presenting a political/rights or regulation frame, a greater number of antitobacco control sources, or government, tobacco industry, tobacco retailers, or tobacco users as sources were significantly less likely to also have a protobacco control slant. CONCLUSIONS: Stories that feature procontrol sources, research evidence and a health frame also tend to support tobacco control objectives. Future research should investigate how to use data, stories and localisation to encourage a protobacco control slant, and should test relationships between content characteristics and policy progression.

Weight-Gain Reduction Among 2-Year College Students: The CHOICES RCT.

INTRODUCTION: The young adult years have been recognized as an influential period for excess weight gain. Non-traditional students and those attending 2-year community colleges are at particularly high risk for a range of adverse weight-related outcomes. DESIGN: Choosing Healthy Options in College Environments and Settings was an RCT with students randomly assigned into a control or intervention condition after baseline assessment. The study was designed to evaluate if a 24-month weight-gain prevention intervention reduces the expected increase in BMI and overweight prevalence in young adults attending 2-year colleges. Two cohorts were recruited, corresponding to the fall and spring semesters. Data collection occurred at four time points for each cohort, with baseline occurring in fall 2011 for Cohort 1 and spring 2012 for Cohort 2. The 24-month follow-up occurred in fall 2013 for Cohort 1 and spring 2014 for Cohort 2. Data analysis occurred in 2015-2016. SETTING/PARTICIPANTS: This research was conducted with 441 students from three community colleges in Minnesota. INTERVENTION: The 24-month intervention began with a 1-credit college course on healthy weight behaviors. A social networking and social support website was introduced as part of the course and participation encouraged for the duration of the trial. MAIN OUTCOME MEASURES: Changes in BMI, weight, body fat percentage, waist circumference, and weight status were assessed. RESULTS: Retention of the cohorts at 24 months was 83.4%. There was not a statistically significant difference in BMI between conditions at the end of the trial. However, there was a statically significant difference in the prevalence of overweight/obesity between treatment conditions at 24 months. Also, participants randomized to the intervention who were overweight or obese at baseline were more than three times as likely to transition to a healthy weight by the end of the trial as compared with control students. CONCLUSIONS: The intervention was not successful in achieving BMI differences between treatment groups. However, an 8% reduction in the prevalence of overweight and obesity over time may have population-level significance. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01134783.

Is frequency of fast food and sit-down restaurant eating occasions differentially associated with less healthful eating habits?

Studies have shown that frequency of fast food restaurant eating and sit-down restaurant eating is differentially associated with nutrient intakes and biometric outcomes. The objective of this study was to examine whether frequency of fast food and sit-down restaurant eating occasions was differentially associated with less healthful eating habits, independent of demographic characteristics. Data were collected from participants in 2015 enrolled in a worksite nutrition intervention trial (n = 388) in North Carolina who completed self-administered questionnaires at baseline. We used multiple logistic regressions to estimate associations between frequency of restaurant eating occasions and four less healthful eating habits, controlling for age, sex, race, education, marital status, and worksite. On average, participants in the highest tertile of fast food restaurant eating (vs. lowest tertile) had increased odds of usual intake of processed meat (OR = 3.00, 95% CI = 1.71, 5.28), red meat (OR = 2.30, 95% CI = 1.33, 4.00), refined grain bread (OR = 2.25, 95% CI = 1.23, 4.10), and sweet baked goods and candy (OR = 3.50, 95% CI = 2.00, 6.12). No associations were found between frequency of sit-down restaurant eating and less healthful eating habits. We conclude that greater frequency of fast food restaurant eating is associated with less healthful eating habits. Our findings suggest that taste preferences or other factors, independent of demographic characteristics, might explain the decision to eat at fast food or sit-down restaurants.

A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial.

BACKGROUND: Obesity in young children remains a public health concern, and maternal weight is one of the strongest predictors of obesity in early childhood. However, parental adherence in interventions for young children is often low and existing programs have had mixed success. An innovative approach to treatment is needed that increases adherence among mothers and improves weight-related behaviors simultaneously in mothers and children. The objective of the Smart Moms randomized controlled trial (RCT) is to test the efficacy of a 6-month primarily smartphone-delivered program to reduce sugar-sweetened beverage and juice consumption among children ages 3-5 whose mothers are overweight or obese. This paper describes the study design and intervention. METHODS/DESIGN: Mother-child dyads were eligible if the mother was overweight or obese, owned a smartphone, and if the child was between the ages of 3-5 and consumed 12 oz or more per day of sugar-sweetened beverages (SSBs) and 100 % fruit juice. Participants were randomly assigned to the Smart Moms intervention or a waitlist control group. The intervention consisted of theoretically grounded and evidence-based behavioral strategies delivered through one group session, lessons on a mobile-optimized website, and text messages. Mothers submitted self-monitoring information via text message and received regular tailored feedback emails from interventionists. The primary outcome is change in child SSB and juice consumption and a secondary outcome is change in maternal weight. DISCUSSION: This Smart Moms study was designed to determine if a low-burden intervention delivered using mobile methods and targeted towards mothers could be effective at changing child sugar-sweetened beverage intake. Results will indicate if mobile-based methods can be a feasible way to engage mothers in family-based studies and will inform successful strategies to prevent childhood obesity through parent-targeted approaches. TRIAL REGISTRATION: Clinicaltrials.gov NCT02098902 (Registered March 25, 2014).

Deconstructing interventions: approaches to studying behavior change techniques across obesity interventions.

Deconstructing interventions into the specific techniques that are used to change behavior represents a new frontier in behavioral intervention research. This paper considers opportunities and challenges in employing the Behavior Change Techniques Taxonomy (BCTTv1) developed by Michie and colleagues, to code the behavior change techniques (BCTs) across multiple interventions addressing obesity and capture dose received at the technique level. Numerous advantages were recognized for using a shared framework for intervention description. Coding interventions at levels of the social ecological framework beyond the individual level, separate coding for behavior change initiation vs. maintenance, fidelity of BCT delivery, accounting for BCTs mode of delivery, and tailoring BCTs, present both challenges and opportunities. Deconstructing interventions and identifying the dose required to positively impact health-related outcomes could enable important gains in intervention science.

Results of a 2-year randomized, controlled obesity prevention trial: Effects on diet, activity and sleep behaviors in an at-risk young adult population.

Excess weight gain tends to occur in young adulthood. However, research examining effective weight-related interventions for this age group has been limited. As one of seven trials in the EARLY Trials consortium (Early Adult Reduction of weight through LifestYle intervention), the CHOICES Study (Choosing Healthy Options in College Environments and Settings) tested effects of a technology-integrated, young adult weight gain prevention intervention. It was a randomized controlled trial with assessments at baseline (2011) and 4-, 12- and 24-months post-intervention initiation and included 441 participants (ages 18-35) who were students at three Minnesota community colleges. The 24-month intervention included a 1-credit academic course and social networking and support online intervention. This analysis examined effects on 12 secondary behavioral outcomes across three domains: diet (fast food, sugary beverages, breakfast, at-home meal preparation), physical activity/screen time (minutes and energy expenditure in leisure time physical activity, television viewing, leisure time computer use) and sleep (hours of sleep, time required to fall asleep, days not getting enough rest, difficulty staying awake). The intervention resulted in significant reductions in fast food (p=0.007) but increases in difficulty staying awake (p=0.015). There was limited evidence of other behavior changes at 4months (0.05

Breakfast and fast food consumption are associated with selected biomarkers in adolescents.

OBJECTIVE: Skipping breakfast and consuming fast food are related to the risk of obesity and are common adolescent behaviors. The relationship between these behaviors and biomarkers related to diabetes and CVD is understudied in this population. METHODS: Data are from a study of the etiologic factors related to obesity risk in adolescents. Breakfast and fast food consumption were assessed using a self-report survey. Anthropometrics, fasting lipids, glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) were assessed. Multivariate analyses were used to examine the relationship between dietary behaviors and selected biomarkers, controlling for calories consumed, body mass index (BMI), and demographic covariates. RESULTS: 367 adolescents (11 to 18-years; mean 14.7 ± 1.8 years) were assessed at the University of Minnesota-Twin Cities from 2006-2008. Breakfast consumption was significantly associated with lower BMI, body fat, insulin, HOMA-IR, and metabolic syndrome (MetS) cluster score, while fast food consumption was associated with higher BMI, body fat, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, HOMA-IR, and MetS cluster score. Some gender differences were observed. CONCLUSION: Breakfast and fast food consumption appear to be related to important metabolic syndrome biomarkers for chronic disease in a sample of healthy adolescents. The importance of this finding needs to be validated by examining the stability of this pattern over time and to assess the pattern in other populations.

Stress, Health Risk Behaviors, and Weight Status Among Community College Students.

The objective of this study was to describe the relationship between stress, weight-related health risk behaviors (e.g., eating behaviors, physical activity, sedentary behavior, sleep, cigarette smoking, and binge drinking), and weight status using cross-sectional data on 2-year community college students enrolled in a randomized controlled weight gain prevention trial. Modified Poisson regression and linear regression were used to examine crude and adjusted cross-sectional associations. Higher stress was associated with higher prevalence of overweight/obesity (crude prevalence ratio [PR] = 1.05; 95% confidence interval [CI: 1.01, 1.09]), though the relationship was no longer statistically significant after controlling for a wide range of weight-related health risk behaviors (adjusted PR = 1.04; 95% CI [1.00, 1.08]). Stress levels were significantly associated with meal skipping and being a current smoker. Future research should investigate the mechanisms through which stress is related to obesity risk and examine the causes of stress among this understudied population to inform the design of appropriate interventions.