Estrogen therapy and variable-resistance weight training increase bone mineral in surgically menopausal women.

This study was undertaken to examine the effect of estrogen replacement therapy alone and estrogen replacement therapy plus variable-resistance weight training on the bone mineral content of surgically menopausal women. A total of 20 surgically menopausal women were randomized and treated with either 0.625 mg conjugated estrogen daily or the same dose of estrogen plus a closely monitored exercise program involving the use of Nautilus muscle strengthening/endurance equipment. After 1 year's observation, the bone mineral density (BMD) of the spine determined by dual-photon absorptiometry increased in the exercising subjects by 8.3 +/- 5.3% (p = 0.004), 95% confidence limits (CL) 3.9-12.8%; the group with estrogen replacement therapy alone maintained their BMD: 1.5 +/- 12.4% (p = 0.36; 95% CL = -6.9-9.8%). The total body BMD of the exercising group increased by 2.1 +/- 1.5% (p = 0.003; 95% CL = 0.8-3.3%); the nonexercising women had a nonsignificant 0.6 +/- 2.9% change (p = 0.30; 95% CL = -1.4-2.5%). A significant increase of 4.1 +/- 4.3% (p = 0.01; 95% CL = 0.8-7.4%) in the radial midshaft BMD of the exercising group was found; the estrogen alone group recorded a nonsignificant change of -0.3 +/- 3.1% (p = 0.33; 95% CL = -1.7-2.4%). The results of this study suggest that variable-resistance training in estrogen-replete women adds bone to both the axial and appendicular skeleton.

Components of the working well trial intervention associated with adoption of healthful diets.

INTRODUCTION: This report examines whether variability in the type and amount of the nutrition intervention in a worksite-based intervention could explain dietary outcomes. METHODS: Data are from 55 intervention worksites in the Working Well Trial, a randomized controlled trial of worksite-based health promotion. The components of the nutrition intervention were kickoff event, direct education, interactive activities (e.g., food sampling), contests, printed information picked up by employees, and materials distributed to employees. We measured delivery of the nutrition intervention (i.e., dose) by determining the amount of workforce participation in each intervention component. Diet outcomes were changes in intakes of fat, fiber, and servings of fruits and vegetables (reported on food frequency questionnaires). All variables were aggregated to the worksite level. We correlated the dose variables with indices of receipt of the intervention and with the dietary outcomes. RESULTS: Contests were associated with employee awareness of and participation in the nutrition intervention (r = 0.49 and 0.28, respectively), and interactive activities were associated with intervention participation (r = 0.43). Contests were associated with increased fiber intake and fruit and vegetable consumption (r = 0.36 and 0.31, respectively), and direct education was associated with fruit and vegetable consumption (r = 0.38). All the above correlation coefficients were statistically significant (P < .05). Intervention dose was not associated with changes in fat intake. CONCLUSIONS: It appears that longer, interactive intervention efforts (contests and classes) resulted in more positive outcomes than did one-time activities (such as the kickoffs) or more passive efforts (use of printed materials). There is a need for studies designed to test worksite- and community-based nutrition intervention methods.

Diet and athletic performance.

Inadequate diet inhibits optimal performance in otherwise well-trained athletes. Controversy exists regarding specific dietary requirements, particularly in the areas of protein and vitamin/mineral supplementation. This article reviews energy substrate utilization, provides an overview of nutrient requirements during exercise, discusses ergogenic aids, and where possible, makes specific dietary recommendations for athletes.

Factors that influence the elderly to use traditional or nontraditional nutrition information sources.

This study analyzed sociodemographic variables, access to medical care, health status-related variables, and nutrition status-related variables to determine their ability to predict an orientation toward traditional or nontraditional nutrition information sources among aged subjects in Eugene, OR. Data were collected from 165 randomly selected subjects by trained interviewers using face-to-face interviews. Nutritionist orientation was measured by a Traditional/Nontraditional Index (TNT Index) developed for the study. Nutrition knowledge and misinformation, supplement use, and sources of nutrition information were also investigated. Predictors of nontraditional nutritionist orientation were acceptance of nutrition misinformation and male sex (adjusted R2 = .09). For women, predictors of a similar orientation were acceptance of nutrition misinformation, low knowledge of general nutrition information, and low functional health status (adjusted R2 = .19). Mean nutrition knowledge scores were high, with a mean of 4.7 (standard deviation [SD] = 0.8) on a scale ranging from 4 (high) to 8 (low). However, many of the subjects did not list dairy foods (28%) and grains (27%) as necessary in the diet. In addition, belief in certain nutrition myths was widespread. More than 58% were taking one or more supplements (mean = 1.4 supplements per day, SD = 1.98). Physicians were mentioned as most likely sources of nutrition information, with dietitians and health food store personnel mentioned second, indicating the importance of marketing efforts for registered dietitians.

The effect of moderate aerobic exercise on physical fitness among women 70 years and older.

This study investigated benefits of 26 weeks of moderate aerobic exercise for women 70 years or older. Sixteen healthy women with a mean age of 72.0 years were randomized into exercise (n = 10) and control groups (n = 6). The exercise group walked on a treadmill 3 times per week for 20 min, at 70% of maximum heart rate. Oxygen uptake VO2max expressed in l/min and ml.kg-1.min-1, total exercise time on the treadmill (TET), maximum heart rate (HRmax) and body mass index (BMI) were measured at baseline and 6 months. Two-way repeated measures analysis of variance (ANOVA) determined the effect of exercise intervention. Both measures of VO2max in addition to TET were significantly improved by the moderate training program, compared to the control group. VO2max in the exercise group increased by +/- 6.6% (S.E. 2.9) measured in l/min and 8.4% (S.E. 3.2) measured in ml.kg-1.min-1. TET increased by 25.4% (S.E. 4.9) in the exercise group. The ANOVA was unable to detect significance between the exercise and control groups for HRmax or BMI. All exercising subjects finished the program, apparently tolerating the intervention. The results indicate that healthy women over the age of 70 years can increase fitness measures with a moderate training program.

A preliminary investigation using drama in community AIDS education.

This investigation assessed the impact of drama on AIDS-related knowledge and beliefs of selected individuals in a university community. Subjects were 136 members of the audience attending two performances of "As Is," the award-winning drama by William Hoffman depicting the illness and inevitable death of a homosexual man with AIDS. The investigation used a pretest-posttest design in which subjects completed a survey instrument before and immediately after the performance. No changes in AIDS-related beliefs were detected as a result of the play. However, knowledge decreased slightly. A linear multiple regression analysis determined variables that contributed significantly to variation in pretest knowledge about AIDS. Pretest knowledge scores were high, particularly in terms of modes of transmission. However, some confusion was evident concerning the concept of casual contact. Though subject responses on a pretest tolerance index generally indicated tolerant beliefs toward people with AIDS, substantial concerns were evident among a minority of subjects. More definitive research is needed to examine the impact of drama as a medium for affecting knowledge and beliefs about AIDS and other complex, emotion-laden health education issues.

Knowledge and misconceptions about the food label among women with non-insulin-dependent diabetes mellitus.

Women on restricted diets are reportedly among the most frequent readers of nutrition information on food labels. However, the specific label information that women with non-insulin-dependent diabetes mellitus (NIDDM) comprehend and use has not been determined. The purpose of this study was to explore the attitude toward, use, and knowledge of information on the food label among rural women with NIDDM age 40 to 60 years. Focus groups and in-depth interviews were conducted. Participants reported that they referred to the nutrition information on the label when grocery shopping and preferred the newly revised format. Yet, comprehension of the terms and percentages on the label was poor (eg, the majority of participants could not explain the difference between total carbohydrate and sugars). Misconceptions also were noted about nutrients listed on the label and the percent daily value. Further education is needed to help people with NIDDM understand and apply the nutrition information on food labels to meet their individual needs.

The relationship between radon knowledge, concern and behavior, and health values, health locus of control and preventive health behaviors.

Understanding similarities between health-related and radon-related knowledge, attitudes, and behaviors may suggest application of effective strategies of radon-related education in targeted populations. A mail survey was returned by 300 randomly selected homeowners in a community at risk for high home radon concentrations (50% response). While 64% were concerned, only 7% tested their homes. The expected association between radon knowledge, radon concern, and information-seeking was identified. In addition, those who tested their homes had greater knowledge and did more information seeking. Health values and radon concern were only weakly related. Environmental concern explained the greatest variance in radon concern (10%). Internal health locus of controls were more likely to have high radon concern. Of the preventive health behaviors, not smoking and seat belt use were the best predictors of variance in radon concern (5%). Segmenting the population is suggested for best educational outcome. Relating information to environmental issues may be helpful. Health-conscious people may need awareness of risks. Issues of self-control and radon testing and reduction may be helpful for some. Synergy between smoke and radon, compounded by smokers lack of concern suggests targeting smokers for education efforts.

Cancer-risk-related health behaviors and attitudes of older workers. Working Well Research Group.

BACKGROUND: The National Cancer Institute's Working Well Trial was a randomized controlled trial of a two-year, comprehensive, worksite-based cancer control intervention. METHODS: Data from 19,582 respondents to the baseline survey were analyzed to determine the relationships between grouped age (18-29, 30-49, 50-54, 55-59, and > 60 years), dietary and smoking behaviors, and attitudes related to participation in health promotion activities. RESULTS: Workers over 50 had more positive health behaviors, stronger beliefs about the value of healthy behavior, and better self-assessed health; they were more likely to hold attitudes associated with participation in worksite health promotion, more positive about work conditions, attributed greater concern about worker health to management, and were more willing to believe that they would be allowed to attend worktime health promotion activities. CONCLUSIONS: Age may be an useful variable in targeting worksite cancer control programming. Workers in their 50s could be supported in weight management, since rates of overweight and obesity are higher in this group. Other health behaviors might be addressed for older workers.

Visual search of food nutrition labels.

Using an eye-tracking methodology, we evaluated food nutrition labels' ability to support rapid and accurate visual search for nutrition information. Participants (5 practiced label readers and 5 nonreaders) viewed 180 trials of nutrition labels on a computer, finding answers to questions (e.g., serving size). Label manipulations included several alternative line arrangements, location of the question target item, and label size. Dependent measures included search time and number of fixations prior to visually capturing the target, as well as the accuracy and duration of the capturing fixation. Practiced label readers acquired the target more quickly and accurately than did less-practiced readers. Targets near the denser center of the label required 33% more time and were harder to find than targets at the top or bottom of the label. Thinner alignment lines were more influential than thicker anchoring lines on visual search time. Overall, the current nutrition label supported accurate and rapid search for desired information. Potential applications of the present methodology include the evaluation of warning labels and other static visual displays.

Development and validation of measures of psychosocial factors influencing fat- and fiber-related dietary behavior.

BACKGROUND: Understanding factors influencing food choices is likely to enhance the effectiveness of strategies to promote healthy eating patterns. This article describes the process used to develop measures of psychosocial factors related to eating patterns in the Working Well project. METHODS: Working Well is a multicenter controlled trial of worksite health promotion interventions, including a nutrition intervention aimed at promoting low-fat, high-fiber eating. The process for developing measures included several steps. First, we defined three domains of psychosocial factors influencing dietary behavior: predisposing, enabling, and change-related factors. We then reviewed large-scale survey findings, compiled a catalogue of items, and developed and refined a 65-item questionnaire for pretesting in a working population. RESULTS: Based on frequency distributions and interitem correlations, the item pool was reduced to 24 items. The 24 remaining items were included in a pilot survey of 652 employees (response rate = 80%). On the basis of pilot data analyses, we eliminated one item and made minor modifications to other items. Factors most strongly associated with dietary intake were self-rated diet, past success at change, and motivation to eat low-fat foods. CONCLUSIONS: Analyses of the cross-sectional pilot data suggest directions for analyses of the final survey. The measures and the development process yielded an instrument and process that can be useful to other researchers.

Psychosocial correlates of healthful diets: baseline results from the Working Well Study.

BACKGROUND: This report examines psychosocial factors related to selection of healthful diets. Understanding why people select healthful diets can lead to rational design and evaluation of nutrition intervention programs. METHODS: Data are from 16,287 respondents to the baseline survey for the Working Well Trial, a randomized, controlled trial of worksite-based health promotion. The psychosocial constructs we measured were predisposing factors (beliefs, perceived benefits, and motivation; 5 items, Cronbach's alpha = 0.65) and enabling factors (barriers, norms, and social support; 6 items, Cronbach's alpha = 0.57). The healthful diet outcomes were intakes of fat, fiber, and servings of fruits and vegetables (from a food frequency questionnaire) and intention and self-efficacy to decrease fat and increase fruits and vegetables. RESULTS: Based on a 5-point scale (1 = low to 5 = high), the mean predisposing factor scale score was much higher than the enabling factor scale score (3.77 vs 2.50, P < 0.001). Comparing respondents in the highest category of the predisposing scale to those in the lowest, mean percentage of energy from fat was 22.4% lower (-9 percentage points), fiber was 85.2% higher (+4.6 g/1,000 kcal), and fruits and vegetables were 100% higher (+1.6 servings/day) (all trends, P < 0.001). Associations were similar, but much weaker, for the enabling scale. Multiple regression models, which included covariates related to diet and the predisposing and enabling scales, explained a total of between 13 and 26% of the variance in diet and intention to change diet. After control for covariates, the predisposing scale remained a significant and strong predictor of diet and intention to change diet but the enabling scale explained small and nonsignificant amounts of variance. CONCLUSIONS: Predisposing factors are strong predictors of current diet and intention to change diet. Final results from the Working Well Trial will provide more information on whether enabling factors can be enhanced by intervention and whether these changes result in healthier eating patterns.

Reducing the risk of cancer through worksite intervention.

This chapter examines existing activities reported in the literature in the areas of smoking, nutrition, and screening; explores the prominent theories of behavior change that have guided some of these activities; and presents a model for worksite cancer prevention programs that is currently being tested in a large trial. A major theme of this chapter is the need for simultaneous changes in individual behaviors and the worksite environment. For each factor (smoking, nutrition, and screening) the discussion is divided into interventions for individuals and those for the environment or organization.

Work site-based cancer prevention: primary results from the Working Well Trial.

OBJECTIVES: This paper presents the behavioral results of the Working Well Trial, the largest US work site cancer prevention and control trial to date. METHODS: The Working Well Trial used a randomized, matched-pair evaluation design, with the work site as the unit of assignment and analysis. The study was conducted in 111 work sites (n = 28,000 workers). The effects of the intervention were evaluated by comparing changes in intervention and control work sites, as measured in cross-sectional surveys at baseline and follow-up. The 2-year intervention targeted both individuals and the work-site environment. RESULTS: There occurred a net reduction in the percentage of energy obtained from fat consumption of 0.37 percentage points (P = .033), a net increase in fiber densities of 0.13 g/1000 kcal (P = .056), and an average increase in fruit and vegetable intake of 0.18 servings per day (P = .0001). Changes in tobacco use were in the desired direction but were not significant. CONCLUSIONS: Significant but small differences were observed for nutrition. Positive trends, but no significant results, were observed in trial-wide smoking outcomes. The observed net differences were small owing to the substantial secular changes in target behaviors.

Measuring participatory strategies: instrument development for worksite populations.

A participatory strategies approach which involves employees in the planning and delivery of worksite health promotion programs was utilized in the 55 experimental worksites included in the national, NCI-funded Working Well Trial. According to study protocol, Employee Advisory Boards (EABs) were organized in each experimental worksite. This paper describes two substudies designed to develop and measure participatory strategies associated with the EABs in the Working Well Trial. Study 1 determined characteristics of the EABs, developed subscales and assessed the internal consistency of the scales. Study 2 used a confirmatory factor analysis to examine the structure of the developed questionnaire. The four subscales include: Autonomy/Independence, Management Involvement, Institutionalization/Commitment and Others Involvement. Results from Study 1 indicate that the four subscales of the 24-item instrument demonstrated strong internal consistency and three were sensitive enough to register differences by Study Center at the baseline. Study 2 results found that the EAB subscales again demonstrated good internal consistency, structural stability and acceptable sensitivity. An initial validity analysis was performed and yielded results which supported some but not all of the hypothesized associations. Implications for further refinement and application of this new instrument in worksite settings are explored.