Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study.

BACKGROUND: Tobacco smoking remains the leading preventable cause of death among American women. Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns, improves affect, and reduces nicotine withdrawal symptoms and cigarette craving. Studies have shown that the practice of yoga improves weight control, and reduces perceived stress and negative affect. Yoga practice also includes regulation of breathing and focused attention, both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes. METHODS/DESIGN: This pilot efficacy study is designed to examine the rates of cessation among women randomized to either a novel, 8-week Yoga plus Cognitive Behavioral Therapy (CBT) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention. Outcome measures include 7-day point prevalence abstinence at end of treatment, 3 and 6 months follow up and potential mediating variables (e.g., confidence in quitting smoking, self-efficacy). Other assessments include measures of mindfulness, spirituality, depressive symptoms, anxiety and perceived health (SF-36). DISCUSSION: Innovative treatments are needed that address barriers to successful smoking cessation among men and women. The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better understand the mechanism(s) by which yoga may act as an effective complementary treatment for smoking cessation. If shown to be effective, yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters. TRIAL REGISTRATION: ClinicalTrials NCT00492310.

Small for gestational age and higher birth weight predict childhood obesity in preterm infants.

We sought to determine the association between small for gestational age (SGA), birth weight, and childhood obesity within preterm polysubstance exposed children. We sampled 312 preterm children with 11-year body mass index (BMI; age- and sex-specific) data from the Maternal Lifestyle Study (51% girls, 21.5% SGA, 46% prenatal cocaine, and 55% tobacco exposed). Multinomial regression analyzed the association between 11-year obesity (OBE) and overweight (OW) and SGA, birth weight, first-year growth velocity, diet, and physical activity variables. Overall, 24% were OBE (BMI for age ≥95th percentile) and 16.7% were OW (BMI ≥85th and <95th percentiles). In adjusted analyses, SGA was associated with OW (odds ratio [OR] = 3.4, confidence interval [CI] 1.5 to 7.5). Higher birth weight was associated with OBE (OR = 1.8, CI 1.3 to 2.4) and OW (OR = 1.4, CI 1.1 to 2.0). Growth velocity was associated with OBE (OR = 2.7, CI 1.8 to 4.0) and OW (OR = 1.6, CI 1.1 to 2.4). Low exercise was associated with OBE (OR = 2.1, CI 1.0 to 4.4) and OW (OR = 2.1, CI 1.0 to 4.5). There was no effect of substance exposure on obesity outcomes. Many (41%) of these high-risk preterm 11-year-olds were obese/overweight. Multiple growth-related processes may be involved in obesity risk for preterm children, including fetal programming as indicated by the SGA effect.

Recruitment and initial interest of men in yoga for smoking cessation: QuitStrong, a randomized control pilot study.

Innovative treatments like yoga for men's smoking cessation (SC) are lacking. To examine the feasibility and acceptability of yoga for men's SC. We randomly assigned eligible men (smoker, ≥5 cigarettes/day, age 18-65) to receive cognitive behavioral therapy for SC, plus a yoga or wellness program. Measures included feasibility (recruitment, class attendance) and acceptability (customer satisfaction). We enrolled 38 of 49 eligible men of 167 screened in response to ads (mean age 39.9 years, ±13.7) who smoked on average 18.6 cigarettes/day (±8.3). Wellness (75.8 %) versus yoga (56 %) men attended more SC classes, p < 0.01. Sixty percent attended ≥1 yoga class. Men reported greater satisfaction with in-house versus community yoga classes. Wellness appears to be the preferred intervention; results indicated that it may be more feasible and showed increased attendance at smoking classes. To be fully feasible, yoga + SC may need to be a unified program offering all classes tailored for men and in the same location.

Acute and Cumulative Effects of Vinyasa Yoga on Affect and Stress among College Students Participating in an Eight-week Yoga Program: A Pilot Study.

BACKGROUND: College students are vulnerable to a critical period in developmental maturation, facing rigorous academic work and learning how to function independently. Western aerobic exercise (WAE), such as running and bicycling, has been shown to improve mood and relieve stress. However, college students often have low levels of physical activity. Yoga is an ancient physical and mental practice that may affect mood and stress. However, rigorous studies examining the psychological effects of yoga are rare in peerreviewed Western journals. The aim of this research was to establish preliminary evidence for the acute effects of Vinyasa yoga on affect and stress in young-adult college students. METHODS: Twenty healthy college students age 18 years and older were recruited to participate in this pilot study. Participants attended a Vinyasa yoga class at a local studio twice weekly for 8 weeks. Affect and stress were assessed before and after each yoga session. Measures included the Positive and Negative Affective Schedule (PANAS) and the Cohen Perceived Stress scale. RESULTS: Positive affect scores increased significantly (p < 0.05) for 14 of the 16 yoga sessions (mean increase = 23.2%). Negative affect decreased significantly from pre- to postyoga (p < 0.05) for 15 of the 16 sessions (mean decrease = 22%). Repeated measures ANOVAs examining pre-post composite scores across all 8 weeks showed significant changes in PANAS, but not stress scores. CONCLUSIONS: Findings suggest that yoga practice is associated with acute improvements in affect in a young-adult college population. Future research is needed to examine the extent to which different types of yoga address the needs of different college sub-populations (e.g., eating disordered, overweight/obese, sedentary, and smokers).

Testing the efficacy of yoga as a complementary therapy for smoking cessation: design and methods of the BreathEasy trial.

INTRODUCTION: Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations. METHODS/DESIGN: The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive-behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL). Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence. CONCLUSIONS: This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research.

Language, duration of United States residency, and leisure time physical activity among women from the Third National Health and Nutrition Examination Survey (NHANES III).

BACKGROUND AND PURPOSE: Physical inactivity is a leading public health concern, particularly among women and ethnic minority groups, where Latinas are among the largest and fastest growing U.S. populations. Acculturation, known to affect other health behaviors, may explain low physical activity (PA) among these underserved women. Research on the effects of acculturation on PA, however, is scarce or limited by methodology. The study purpose was to evaluate the association between acculturation (i.e., language, birth country, and duration of U.S. residency) and PA in a national sample of women within the framework of the socioecologic model of health promotion. METHODS: A total of 5,861 women (86% white, mean age 37.2) were sampled from the Third National Health and Nutrition Examination Survey (NHANES III). RESULTS: Hierarchical multivariable regression modeling results indicate significant associations among language, duration of U.S. residency, and age, after controlling for confounders (all p<0.05). Most women reported less than recommended PA. CONCLUSIONS: These findings indicate that age, duration of U.S. residency, and language are important to consider in combination when understanding women's PA, findings that have implications for future research, theory, and clinical practice (e.g., making available PA assessments in multiple languages additionally tailored on age and investigating sociopolitical factors unique to Latinas).

Prenatal cocaine exposure and childhood obesity at nine years.

Little is known about the association between prenatal cocaine exposure and obesity. We tested whether prenatal cocaine exposure increases the likelihood of obesity in 561 9-year-old term children from the Maternal Lifestyle Study (MLS). Overall, 21.6% of children met criterion for obesity (body mass index [BMI] ≥ 95th percentile, age and sex-specific). While there was no overall cocaine effect on obesity, multivariate logistic analysis revealed that children exposed to cocaine but not alcohol were 4 times more likely to be obese (OR 4.11, CI 2.04-9.76) than children not exposed to either drug. No increase in obesity prevalence was found in children exposed to alcohol but not cocaine (OR 1.08, CI .59-1.93) or both (OR 1.21, CI 0.66-2.22). Alcohol exposure may attenuate the effect of cocaine exposure on obesity. Increased obesity associated with cocaine but not alcohol exposure was first observed at 7 years. BMI was also elevated from 3 to 9 years in children exposed to cocaine but not alcohol, due to increasing weight but normal height. Prenatal exposure to cocaine may alter the neuroendocrine system and metabolic processes resulting in increased weight gain and childhood obesity.