Is waist circumference ≥102/88cm better than body mass index ≥30 to predict hypertension and diabetes development regardless of gender, age group, and race/ethnicity? Meta-analysis.

Between body mass index (BMI) ≥30 and waist circumference (WC) ≥102/88cm, we investigated which of the two measures is a better predictor of two of the most common chronic diseases - diabetes mellitus and hypertension while also examining differential association by gender, age group, and race/ethnicity. Meta-analysis was conducted for all longitudinal studies with at least 12months of follow-up published up to April 2015. Ratio of relative risk (rRR) and relative risk of diseases were computed and compared by baseline obesity measurement. The final sample included 23 longitudinal observation studies involving 62 study arms with 259,200 individuals. WC≥102/88cm was a better predictor than BMI≥30 for development of diabetes (rRR=0.81, 95% CI=0.68-0.96), but not for hypertension (rRR=0.92, 95% CI=0.80-1.06). Subgroup analyses showed WC≥102/88cm was a better predictor for diabetes in women than men, and for ages 60 and older than other ages. Only WC≥102/88cm, not BMI≥30, predicted development of hypertension among Hispanic/Latinos. Neither BMI≥30 nor WC≥102/88cm were significant predictors of hypertension when age group was controlled. Central obesity may be a more serious risk factor for diabetes development in women and for older ages. The predictive power of BMI≥30 or WC≥102/88cm in hypertension development should not be emphasized as either could mask the effect of age.

Exercise in Young Adulthood with Simultaneous and Future Changes in Fruit and Vegetable Intake.

OBJECTIVES: Regarding weight management, changes in exercise behavior can also influence nutrition behavior by application of self-regulatory psychological resources across behaviors (transfer effect). This study aimed to determine: (1) if changes in exercise frequency in young adulthood predict simultaneous changes in fruit/vegetable intake (transfer as co-occurrence); and (2) if exercise frequency affects future fruit/vegetable intake (transfer as carry-over). METHODS: 6244 respondents of the National Longitudinal Survey of Youth 1997 were followed at ages 18-22 (Time-1), 23-27 (Time-2), and 27-31 (Time-3). Repeated measures analysis of variance and hierarchical multiple regression determined if the change in exercise frequency between Time-1 and Time-2 was associated with simultaneous and sequential changes in fruit/vegetable intake frequency, controlling for sex, race/ethnicity, education, income, body mass index, and baseline fruit/vegetable intake. RESULTS: Only 9% continued exercising for 30 minutes more than 5 days/week, while 15% transitioned to adequate exercise and another 15% transitioned to inadequate exercise; for both fruits and vegetables, intake of once per day or more increased with age. Males were more likely to exercise adequately and females to consume fruits/vegetables adequately. Exercise frequency transition was linearly associated with concurrent fruit/vegetable intake during Time-1 and Time-2. The highest increase in mean fruit/vegetable intake occurred for participants who transitioned from inadequate to adequate exercise. A significant Time-2 exercise frequency effect on Time-3 fruit/vegetable intake emerged, after accounting for baseline intake. Increase in Time-2 exercise by one day/week resulted in increased Time-3 fruit and vegetable intakes by 0.17 and 0.13 times/week, respectively. CONCLUSION: Transfer effects, although usually discussed in interventions, may also be applicable to voluntary behavior change processes. Newly engaging in and continuing exercise behavior over time may establish exercise habits that facilitate improved fruit/vegetable consumption. Interventions that facilitate transferring resources across behaviors likely will enhance this effect.

Measuring outcome expectancy value of leisure-time physical activity for African Americans.

A scale was adapted from existing scales to measure the outcome expectancy value (EV) as one of contributory factors to leisure-time physical activity (LTPA) and was administered to 649 African American adults. The eligible participants (N = 569) for the analysis were split into three subsamples (rate = 0.5 : 0.25 : 0.25) respectively for Exploratory Factor Analysis (N = 285) and cross-validation (N = 142 for the calibration group and N = 142 for the validation group) to evaluate the psychometric properties of the scale. Item analysis of the scale provided adequate psychometric properties. The 2-factor solution with positive and negative outcome EV subscales was supported based on the exploratory factor analysis and the multiple-group confirmatory factor analysis for both the calibration and validation samples. The results support the factorial construct validity and criterion validity of the outcome EV scale applied to assess LTPA in a sample of church-going African Americans.

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults.

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (ß = .52, p < .01) and reduces the time required to complete physical functions (ß = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Evaluation of Intravenous Push Piperacillin-Tazobactam on Time to Antibiotic Administration in Emergency Department Patients with Sepsis.

Purpose: The purpose of this study was to determine if intravenous push (IVP) administration of piperacillin-tazobactam reduced the time to antibiotic administration compared to intravenous piggyback (IVPB) in emergency department (ED) patients who present with sepsis. Methods: This was a retrospective cohort study of patients with sepsis who received piperacillin-tazobactam before and after implementation of an IVPB to IVP conversion protocol. Results: A total of 486 charts were reviewed and the final analysis included 127 patients in each group. The mean time to administration of piperacillin-tazobactam was 67 (± 48) minutes and 58 (± 36) minutes in the IVPB and IVP cohorts, respectively (P = NS). The time to administration of secondary antibiotics was reduced by 38 minutes in patients who received piperacillin-tazobactam by IVP (105 min ±69 vs 67 min ±37; P < .001). Nurse administration time was reduced by 11 min for piperacillin-tazobactam (54 min ±46 vs 43 min ±33; P = .034) and 40 min for secondary antibiotics (90 min ±67 vs 50 min ±32; P = < .001) in the IVP group. There was no difference in hypersensitivity reactions, hospital length of stay, or mortality. Conclusion: Conversion from piperacillin-tazobactam IVPB to IVP was associated with a reduction in time to piperacillin-tazobactam and secondary antibiotic administration in emergency department patients with sepsis. Further prospective research is needed to evaluate clinical outcomes associated with IVP administration.

A comparison of factors associated with physical inactivity among East Asian college students.

BACKGROUND: Little is known on the level of physical inactivity and its behavioral and cultural correlates among East Asian college students. PURPOSE: The aim of this study is to examine and compare the level and behavioral and cultural correlates of physical inactivity among college students in Taiwan, Hong Kong, South Korea, Singapore, and Malaysia. METHOD: Data were collected from a representative sample of college students (N = 12,137) in five East Asian economies during the 2008-2009 academic year. The stratified random sampling (stratum: geographic region) was used to select participating institutions. The overall response rate was 77%. RESULTS: The percentage of physically inactive students was 7.2% for Singapore, 8.0% for Malaysia, 13.5% for Taiwan, 16.8% for Hong Kong, and 28.5% for South Korea. When gender, age, and body mass index were controlled, fruit and vegetable consumptions were significant correlates for physical inactivity across all the five economies. In Hong Kong, Korea, and Taiwan, those who engaged in binge drinking at least once during the past 2 weeks were less likely to be physically inactive than those who did not. Religion and military experience did not independently predict physical inactivity in any of the five economies. CONCLUSION: Physical inactivity varies greatly across different economies in East Asia that are usually grouped together and considered a single homogeneous entity by some researchers. However, in terms of correlates of physical inactivity, findings of the current study indicate that the transversal value of physical activity might be transformed into a universal.

A decade of sustaining best practices for tobacco control: Indiana's story.

The Indiana Tobacco Prevention and Cessation Agency (ITPC) was created in 2000 to address high tobacco use rates. This independent state agency, using Centers for Disease Control and Prevention (CDC) Best Practices for Comprehensive Tobacco Control Programs, administered a comprehensive program that supported community health coalitions and evidence-based public policy changes. From 2000 to 2011, ITPC operated in difficult budgetary and political environments and with less than 20% of the funding recommended by CDC. ITPC and its partners enabled social and cultural changes, reduced cigarette use rates, and increased the number of community smoke-free environments. Public health leaders in Indiana agreed that the independent agency model was effective in reducing the costs associated with tobacco-use-related disease and death. Despite broad public support for ITPC and its work, on April 29, 2011, the Indiana legislature passed a controversial budget bill that abolished the ITPC executive board and transferred its budget and function to the Indiana State Department of Health (ISDH). Although the tobacco control program is not insulated from political interference, the ISDH commissioner has created a new Tobacco Prevention and Cessation Commission, whose members report directly to him, with commitment to continue the programmatic focus of the former ITPC. Restoring full funding to the tobacco control program is necessary if Indiana's goal of decreasing the health care and business costs of tobacco use-related diseases are to be achieved.

Alcohol use behavior among undergraduates: a cross-cultural comparison between the United States and Sri Lanka.

In this study, the alcohol use behaviors and associated factors of US and Sri Lankan undergraduates were compared. A sample of 515 US (63% female) and 583 Sri Lankan (54% female) undergraduates were surveyed using a self-administered, anonymous questionnaire. Significant variations by gender and country existed. In the US sample, 89.5% of males and 76.5% of females were current alcohol users; in the Sri Lankan sample, 30.5% of males and 3.5% of females were current alcohol users. For both sexes, the reported mean monthly consumption rate (units/month) was higher in the US sample (male=25.6, female=16.4) compared to that of the Sri Lankan sample (male=8.1, female=8.4). In the US sample, the mean alcohol consumption rates reported were higher in first-year undergraduates compared to undergraduates in subsequent years of study. In contrast, mean alcohol consumption was lower in junior undergraduates compared to senior undergraduates in the Sri Lankan sample. Living arrangements (on-campus vs off-campus) seemed to be unrelated to alcohol use in the US undergraduates, but living in off-campus residences seems to be a protective factor of alcohol use for the Sri Lankan undergraduates. Those implementing prevention strategies should seriously consider these culture-specific drinking habits and motives, and other factors, such as gender, when formulating undergraduate alcohol-control interventions.

Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka.

Background and aim: Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka. Methods: A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis. Results: The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults. Conclusions: Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.

The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes.

OBJECTIVE: To evaluate the impact of a smoke-free campus policy on college students' smoking behaviors and attitudes. METHODS: The current study utilized repeated cross-sectional surveys with a nested 4-wave longitudinal cohort design. Data were collected from undergraduate students at two large matched public universities in Indiana before and after one of the campuses went smoke-free in January 2008. Baseline data were collected in fall 2007 (n=3266) and follow-up data were collected in fall 2009 (n=3207). In addition, volunteers provided longitudinal follow-up data at four different time points. RESULTS: In the cross-sectional analyses, students exposed to the smoke-free campus policy demonstrated significant favorable changes in smoking behavior (16.5% to 12.8%, p<0.001), perceptions of peer tobacco use (73.6% to 66.8%, p<0.001), and smoking norms (45.5% to 40.4%, p<0.001) compared to students on the control campus. In the longitudinal analyses, students exposed to the smoke-free campus policy demonstrated these changes plus significant favorable changes in attitudes toward regulation of tobacco (83.2% to 89.9%, p<0.01). CONCLUSIONS: The implementation of a smoke-free campus policy may be an effective intervention for reducing tobacco use among college students.

A cross-sectional survey on the inclusion of tobacco prevention/cessation, nutrition/ diet, and exercise physiology/fitness education in medical school curricula.

Chronic diseases are currently the major cause of death and disability worldwide. Addressing the main causes of chronic diseases from a preventive perspective is imperative for half ing a continual increase in premature deaths. Physicians occupy a unique position to assist individuals with chronic disease prevention. Hence, medical school is an opportunity to prepare physicians for preventive interventions with patients at risk for developing chronic diseases. This study asserts that education on chronic disease prevention that targets tobacco cessation/prevention, nutrition/ diet, and exercise physiology/fitness is a key aspect of medical school curricula. However, many US medical schools do not include all 3 components in their curricula. This study investigates the extent to which medical school curricula include the above 3 areas. Two methods were utilized for the study: (1) a cross-sectional survey was given to the associate dean of academic affairs of 129 US medical schools and (2) relevant data were retrieved from the Association of American Medical Colleges. Findings support the notion that medical schools are in need of increased curricula covering tobacco prevention/cessation, nutrition/diet, and exercise physiology/fitness. Results indicate that exercise physiology/fitness was the area receiving the least attention in medical schools. Ultimately, this study's purpose was to provide a basis for determining whether inclusion of these 3 subjects in medical school curricula has any significant effect on training future doctors to meet the needs of growing numbers of individuals with chronic disease.

Structural Factors and Quality of Diabetes Health Services in Hail, Saudi Arabia: A Cross-Sectional Study.

The chronic disease burden in Saudi Arabia has created adverse health, social and economic consequences that require urgent attention from health and political authorities. Diabetes has become an epidemic in Saudi Arabia. Data on personal and structural factors associated with diabetes in the Hail region are scarce. Such data are imperative to develop effective strategies to control the epidemic in the region. A cross-sectional study of diabetes patients attending diabetes health care facilities in Hail was conducted using a sample of 392 patients. An interviewer-administered questionnaire was used. A slightly higher proportion of female participants (54.1%) were included in the sample. Most of the participants were from rural areas (73.9%), and 70.9% of the participants were from the middle-age (30-50 years) category. A close proximity to the diabetes clinic (OR = 1.98; 95% CI: 1.08-3.44), good transport facilities (OR = 1.67; 95% CI: 1.11-2.78) and feeling contented with supportive services (OR = 2.03; 95% CI: 1.12-4.04) were associated with patients' satisfaction with the overall quality of the diabetes clinic services. The presence of good-quality health care professionals working in these treatment centers also seemed to contribute to patients' satisfaction with the services they received. These structural factors associated with patients' satisfaction with the services they received from diabetes clinics must be considered in diabetes control programs in the region. The minimization of structural barriers will eventually assist the national strategic plan, Vision 2030, which aims to improve the quality of life of the Saudi people by 2030.

Cross-cultural comparison of lack of regular physical activity among college students: Universal versus transversal.

PURPOSE: This study examined cultural influence on personal and behavioral correlates of lack of regular physical activity (PA) among college students in four countries, i.e., the United States, Costa Rica, India, and South Korea. METHOD: Public universities were randomly chosen among the four countries. A total of 4,685 students participated in the study during the 2006-2007 academic year with a response rate of 90.1%. The vast majority of the questions on the instrument were adopted from the Youth Risk Behavior Survey and the Behavioral Risk Factor Surveillance System questionnaires. The instrument was translated into Spanish and Korean and then back-translated into English to check accuracy of the translation. RESULTS: Low fruit consumption was a culture-universal predictor of lack of regular PA. Gender, perceived body weight, vegetable consumption, and cigarette smoking were culture-specific predictors, indicating PA might be a transversal value. Body mass index, binge drinking, and TV/video watching were not associated with lack of regular PA in any of the four countries. CONCLUSION: While PA is valued across different segments of many cultures, given the several culture-specific predictors, PA appears to be more transversal than universal. Therefore, culturally sensitive interventions are necessary to promote PA among young adults.

Factors influencing openness to future smoking among nonsmoking adolescents.

BACKGROUND: To investigate the correlates of youth tobacco use in terms of nonsmoking adolescents' openness to future smoking, a secondary analysis of the 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) was conducted. METHODS: A representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed in 2000, and 3433 public high school students and 1990 public middle school students (63.04% and 65.44% response rates, respectively) were surveyed in 2004. RESULTS: Seventy-four percent of students in 2000 were not open to future smoking and 77% were not open in 2004. The adolescent cohort in 2004 became more exposed to antitobacco messages and less exposed to protobacco messages and environmental tobacco smoke (ETS) compared with their counterpart in 2000. Whereas gender, grade, race/ethnicity, and exposure to antitobacco messages were insignificant predictors for openness to future smoking, exposure to ETS either in homes or in cars was a strong predictor for openness to future smoking (the higher the exposure to ETS, the more open to future smoking) in both unadjusted and adjusted multivariate models. Exposure to protobacco messages had a greater effect on openness to future smoking than exposure to antitobacco messages. The rate of transition from openness to future smoking to tobacco use initiation is higher among white adolescents than among minority adolescents. CONCLUSIONS: More efforts should be made to reduce adolescents' exposure to ETS and protobacco messages.

Population-Level Measures to Predict Obesity Burden in Public Schools: Looking Upstream for Midstream Actions.

PURPOSE: To estimate school-level obesity burden, as reflected in prevalence of obesity, based on the characteristics of students' socioeconomic and geographic environments. DESIGN: Secondary analysis of cross-sectional data. SETTING: Public schools (N = 504) from 43 of 67 counties in Pennsylvania. PARTICIPANTS: Kindergarten through grade 12 students (N = 255 949). MEASURES: School-level obesity prevalence for the year 2014 was calculated from state-mandated student body mass index (BMI) measurements. Eighteen aggregate variables, characterizing schools and counties, were retrieved from federal data sources. ANALYSIS: Three classification variables-excess weight (BMI ≥ 85th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI > 35% or 120% of 95th percentile)-each with 3 groups of schools (low-, average-, and high-prevalence) were created for discriminant function analysis, based on state mean and standard deviation of school distribution. Analysis tested each classification model to reveal school- and county-level dimensions on which school groups differed from each other. RESULTS: Discriminant functions for obesity, which contained school enrollment, percentage of students receiving free/reduced-price lunch, percentage of black/Hispanic students, school location (suburban/other), percentage of county adults with postsecondary education, and percentage of county adults with obesity, yielded 67.86% correct classification (highest accuracy), compared to 34.23% schools classified by chance alone. CONCLUSION: In the absence of mandated student BMI screenings, the model developed in this study can be used to identify schools most likely to have high obesity burden and, thereafter, determine dissemination of enhanced resources for the implementation of proven prevention policies and programs.

Longitudinal Trajectory of the Relationship Between Self-Esteem and Substance Use From Adolescence to Young Adulthood.

BACKGROUND: We examined the longitudinal trajectory of substance use (binge drinking, marijuana use, and cocaine use) in relation to self-esteem from adolescence to young adulthood. METHODS: Generalized estimating equation models were fit using SAS to investigate changes in the relation between self-esteem and each substance use (binge drinking, marijuana use, and cocaine use) from adolescence to young adulthood. Data were drawn from the 3 waves of the National Longitudinal Study of Adolescent Health, a nationally representative sample of middle and high school students in the United States (N = 6504). RESULTS: Self-esteem was a significant predictor for the use of all 3 substances at 15 years of age (ps < .001). However, at age 21, self-esteem no longer predicted binge drinking and marijuana use in the controlled model. CONCLUSIONS: It appears that self-esteem loses its protective role against substance use except cocaine use as adolescents transition to young adulthood.

Inhalant use among indiana school children, 1991-2004.

OBJECTIVE: To examine the prevalence and trend of inhalant use among Indiana public school students. METHODS: The Alcohol, Tobacco, and Other Drug Use among Indiana Children and Adolescents surveys conducted annually between 1991 and 2004 were reanalyzed using 2-way moving average, Poisson regression, and ANOVA tests. RESULTS: The prevalence had increased during 1991- 1997, decreased during 1997- 2002, and increased again since 2003. Poisson model estimated an average annual decrease rate of 5.6%. The intensity of inhalant use had also decreased. More males and Hispanics use inhalants. CONCLUSION: Inhalant use needs to be addressed in drug prevention programs.

The longitudinal trajectory of post-surgical % total weight loss among middle-aged women who had undergone bariatric surgery.

Middle-aged women are at a higher risk of being obese. We examined the trajectory of post-surgical % total weight loss (%TWL) among middle-aged female bariatric patients. We fitted sequential generalized estimating equations models to analyze a sample of women who received bariatric surgery in 1995-2012, aged 40-65 years at the time of surgery (N = 158,292) whose pre-operative body mass index (BMI) was ≥ 30 kg/m2 in the Bariatric Outcomes Longitudinal Database. The %TWL computed by 100% × (pre-surgery BMI - post-surgery BMI) / pre-surgery BMI showed different trajectories depending on type of surgery. For gastric banding, %TWL increased rapidly right after bariatric surgery and started to decrease around 1 year after surgery. For Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy, %TWL overall did not show remarkable changes from around 1 year after surgery. The highest increase in %TWL was observed in patients whose pre-operative BMI was 40 or higher and those who had undergone RYGB (ps < 0.001). Whereas the trajectories of %TWL among patients with sleeve gastrectomy and gastric banding did not differ much between different pre-operative BMI groups, the trajectories for RYGB were notably different between different pre-operative BMI groups (ps < 0.001). Middle-aged female bariatric patients are likely to achieve the highest %TWL if they receive RYGB and if their pre-operative BMI is 40 or higher. Further research is warranted to corroborate the present study's finding on the long-term effect of different types of bariatric surgery on %TWL among middle-aged women.

Effects of preventive online mindfulness interventions on stress and mindfulness: A meta-analysis of randomized controlled trials.

Empirical evidence suggested that mind-body interventions can be effectively delivered online. This study aimed to examine whether preventive online mindfulness interventions (POMI) for non-clinical populations improve short- and long-term outcomes for perceived-stress (primary) and mindfulness (secondary). Systematic search of four electronic databases, manuscript reference lists, and journal content lists was conducted in 2016, using 21 search-terms. Eight randomized controlled trials (RCTs) evaluating effects of POMI in non-clinical populations with adequately reported perceived-stress and mindfulness measures pre- and post-intervention were included. Random-effects models utilized for all effect-size estimations with meta-regression performed for mean age and %females. Participants were volunteers (adults; predominantly female) from academic, workplace, or community settings. Most interventions utilized simplified Mindfulness-Based Stress Reduction protocols over 2-12 week periods. Post-intervention, significant medium effect found for perceived-stress (g = 0.432), with moderate heterogeneity and significant, but small, effect size for mindfulness (g = 0.275) with low heterogeneity; highest effects were for middle-aged individuals. At follow-up, significant large effect found for perceived-stress (g = 0.699) with low heterogeneity and significant medium effect (g = 0.466) for mindfulness with high heterogeneity. No publication bias was found for perceived-stress; publication bias found for mindfulness outcomes led to underestimation of effects, not overestimation. Number of eligible RCTs was low with inadequate data reporting in some studies. POMI had substantial stress reduction effects and some mindfulness improvement effects. POMI can be a more convenient and cost-effective strategy, compared to traditional face-to-face interventions, especially in the context of busy, hard-to-reach, but digitally-accessible populations.

Racial/ethnic differences in body mass index, morbidity and attitudes toward obesity among U.S. adults.

OBJECTIVE: To describe racial/ethnic differences by gender in body mass index (BMI), to examine the relationship between existence of current morbidity and BMI, and to assess racial/ethnic disparities in attitudes and perceptions toward obesity. DESIGN AND SETTING: Cross-sectional random-digit telephone survey of a representative sample of noninstitutionalized U.S. adults aged > or =18 years in 2005 (N = 1,000, 62% response rate and 82% cooperation rate). RESULTS: The prevalence of overweight or obesity in 2005 among U.S. adults was 63%. Racial disparities in obesity were observed among women, not among men. The mean BMI of non-Hispanic black women was 29.8, significantly (P < 0.01) higher than that of non-Hispanic white women (26.7). Eighteen percent of the respondents reported having serious morbidities, with 8.5% reporting diabetes. A dose-response relationship was observed between BMI groups and existence of morbid conditions. Twenty-seven percent of obese respondents (BMI > or = 30) and 55% of extremely obese respondents (BMI > or = 40) reported such conditions. Race (blacks versus whites) was not a significant predictor for any of the six different attitudes and perceptions toward obesity in fully adjusted logistic models. CONCLUSIONS: There is no evidence of plateau or decrease in the prevalence of overweight or obesity and diabetes among U.S. adults. Racial disparities between blacks and whites persist among women. A modification of attitudes and perceptions might not have significant effects on people's behavior that can influence the prevalence of overweight and obesity.