Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial.

OBJECTIVE: Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management. The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight, glycemic control, renal function, and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms. METHODS: A sample of 111 adults with Type 2 diabetes were randomly assigned to a 1-year intervention (n = 57) or usual care (n = 54) in a parallel groups design. Primary outcomes included weight, glycosylated hemoglobin, and Beck Depression Inventory II score. Estimated glomerular filtration rate served as a secondary outcome. All measures were assessed at baseline and 6 and 12 months after randomization by assessors blind to randomization. Latent growth modeling was used to examine intervention effects on each outcome. RESULTS: The intervention resulted in decreased weight (mean [M] = 0.322 kg, standard error [SE] = 0.124 kg, p = .010) and glycosylated hemoglobin (M = 0.066%, SE = 0.028%, p = .017), and Beck Depression Inventory II scores (M = 1.009, SE = 0.226, p < .001), and improved estimated glomerular filtration rate (M = 0.742 ml·min·1.73 m, SE = 0.318 ml·min·1.73 m, p = .020) each month during the first 6 months relative to usual care. CONCLUSIONS: Multicomponent behavioral interventions targeting weight loss and depressive symptoms as well as diet and physical activity are efficacious in the management of Type 2 diabetes. TRIAL REGISTRATION: This study is registered at Clinicaltrials.gov ID: NCT01739205.

Lifestyle modification and weight reduction among low-income patients with the metabolic syndrome: the CHARMS randomized controlled trial.

Although weight is an important intervention target among patients with metabolic syndrome, few trials have recruited low-income minority populations. The Community Health and Risk-reduction for Metabolic Syndrome randomized controlled trial aimed to examine the effects of a lifestyle intervention on weight and metabolic syndrome components among low-income minority adults. We randomized 120 adults with metabolic syndrome to standard medical care (N = 60) or a lifestyle intervention (N = 60). Using an intent-to-treat approach, we found significant intervention effects on weight [B = -0.452; SE = 0.122; 95 % confidence intervals (CI) -0.653 to -0.251) and glucose levels at 6-months (B = -0.522, SE = 0.234, 95 % CI -0.907 to -0.138). These changes were maintained through the 12-month assessment. No significant effects were observed on insulin resistance or other metabolic syndrome components. Our intervention was successful in achieving modest but significant weight loss and reduction in fasting glucose among low-income minority subjects with metabolic syndrome.

Cardiovascular reactivity and cardiometabolic risk in adolescents.

BACKGROUND: Cardiovascular reactivity has been examined as a risk marker or factor in the pathogenesis of hypertension or cardiovascular disease, but few have examined the relationship with the metabolic syndrome. PURPOSE: We examined whether cardiovascular reactivity to laboratory stress is associated with individual cardiometabolic risk factors and their co-occurrence. A significant positive relationship was hypothesized for both individual and clustered risk factors in their cross-sectional associations with reactivity to multiple stressors. METHODS: A sample of 144, 15-17-year-old adolescents (74 % boys) largely from ethnic minority groups (54 % Hispanic White, 26 % Black) were identified at annual blood pressure (BP) screening (39 % with elevated BP) at high schools in Miami, Florida, USA. Participants completed the evaluated speaking, mirror star tracing, and cold pressor tasks, as well as cardiometabolic risk factor blood sampling. Participants were classified into metabolic syndrome criterion groups (0, 1, 2, or ≥3 criteria) based on American Heart Association adult criteria. RESULTS: Multiple regression analyses with individual metabolic syndrome variables demonstrated that diastolic (D)BP reactivity during the mirror star tracing task accounted for 1.3 %, 3.8 %, and 5.1 % of the respective variances in casual systolic BP, waist circumference, and triglycerides (ps < 0.05). In multinomial logistic regression models, increased DBP reactivity during mirror star tracing and cold pressor tasks, and decreased HR reactivity during the cold pressor, were associated with greater likelihood of risk factor co-occurrence (ranging from 8.3 % to 15.8 %). CONCLUSIONS: Findings indicate that autonomic reactivity to the mirror star tracing and cold pressor tasks, but not the evaluated speaking task, is associated with risk factor co-occurrence, and reactivity may be a clinical prognosticator of cardiometabolic disease risk.

Leptin and its association with somatic depressive symptoms in patients with the metabolic syndrome.

BACKGROUND: This study aimed to determine the association between circulating leptin levels and total depressive symptoms as well as depressive symptom dimensions (cognitive and somatic) after controlling for important confounding factors. METHODS: The study sample was comprised of 135 participants with the metabolic syndrome. Depressive symptoms were measured using the Beck Depression Inventory-II. Leptin was measured using a leptin-specific enzyme immunoassay. Inflammation was assessed using C-reactive protein and interleukin-6 levels. RESULTS: Leptin was significantly associated with somatic depressive symptoms (ß = 0.33, P = 0.018), but not total depressive symptoms (ß = 0.27, P = 0.067) or cognitive depressive symptoms (ß = 0.21, P = 0.182), after controlling for age, gender, body mass index, and insulin resistance. Further adjustment for C-reactive protein and interleukin-6 levels did not alter the relationship (ß = 0.32, P = 0.023) between circulating leptin levels and somatic depressive symptoms. CONCLUSIONS: Leptin is independently associated with somatic depressive symptoms in patients with the metabolic syndrome.

Cardiometabolic risk in adolescents: associations with physical activity, fitness, and sleep.

BACKGROUND: Physical activity and fitness are independently associated with cardiometabolic dysfunction, and short sleep duration is an emerging marker of obesity. Few have examined interrelations among these factors in a comprehensive risk model. PURPOSE: Investigate the influence of behavioral and lifestyle risk factors on the metabolic syndrome and inflammation. METHODS: A sample of 367 15-17-year-olds (73 % boys) from ethnic minority groups (45.8 % Hispanic, 30.8 % Black), most with elevated blood pressure (72 %), underwent aerobic fitness testing, blood sampling, and completed behavioral questionnaires. RESULTS: Structural model results are consistent with the notion that short sleep duration, poor sleep quality and fatigue, and decreased physical activity are associated with increased risk of metabolic syndrome and inflammation possibly via effects on reduced cardiorespiratory fitness. CONCLUSIONS: The combination of negative lifestyle and behavioral factors of physical inactivity, sleep loss, and poor fitness has serious implications for cardiovascular health complications in at-risk youth.

Elevated body mass index and obesity among ethnically diverse adolescents.

OBJECTIVE: To examine trends in prevalence and odds of elevated body mass index (BMI) and obesity among ethnically diverse adolescents. DESIGN AND SETTING: Data from countywide (Miami-Dade) health screenings from 1999-2005. Weight, height, days/week of vigorous activity, hours/day of sedentary activity, parental hypertension, and eating habits were reported. PARTICIPANTS: 77,050 adolescents, average age 15.6 years (51% girls, 9.4% White non-Hispanic, 59.2% White Hispanic, 16.4% African American, 7% Black Hispanic, and 8% Black Caribbean). OUTCOME MEASURES: Prevalence and ethnic differences in odds of obesity (BMI > or = 95th percentile) and elevated BMI (BMI > or = 85th percentile), adjusting for academic years, days/week of vigorous activity, and hours/day of sedentary activity. RESULTS: Prevalence of elevated BMI and obesity increased from 1999-2005. Overall, White non-Hispanics had lower odds of obesity and elevated BMI than African Americans and White Hispanics. African American girls displayed higher odds of obesity and elevated BMI than Black Hispanic girls and higher odds of elevated BMI than Black Caribbean girls. African American boys showed higher odds of obesity and elevated BMI than Black Caribbean boys. Black Hispanic girls had greater odds of obesity and elevated BMI than White Hispanic girls, but boys were similar. CONCLUSIONS: This study is among the first to examine BMI status in both Black and Hispanic subgroups. Viewing Black and Hispanic ethnic subgroups as homogeneous obscures important weight-related differences. Further research is warranted to determine factors contributing to differential risk.

Are Self-Efficacy and Weight Perception Associated With Physical Activity and Sedentary Behavior in Hispanic Adolescents?

Little is known about the correlates of physical activity and sedentary behavior in Hispanic adolescents. This study examined at baseline and 2-year follow-up: (1) the relationship between self-efficacy for physical activity and physical activity, (2) the association of weight perception with physical activity and sedentary behavior, and (3) whether sex moderated these associations. Hispanic adolescents ( N = 483 at baseline; age 15-17 years; 55.1% girls) completed questionnaires that assessed their self-efficacy for physical activity, weight perception, and time spent in physical activity and sedentary behavior. Multiple-group path analyses were conducted to examine the proposed relationships and determine whether they were moderated by sex. Models controlled for body mass index, weight loss intention, participation on a sports team, language spoken at home, parental education, and country of birth. Self-efficacy was related to time spent in physical activity in boys ( b = .35, p < .001) and girls ( b = .41, p < .001) at baseline, but not 2 years later. No association was found for weight perception and time spent in physical activity and sedentary behavior. Post hoc analyses for overweight participants at baseline showed that weight perception was associated with time spent watching television. Overall, the findings suggest that self-efficacy is an important correlate, but not a predictor, of physical activity among Hispanic adolescents. Including strategies to address and enhance self-efficacy for physical activity in lifestyle interventions may increase adherence to physical activity recommendations and help reduce the high prevalence of obesity in this population.

Stress management effects on perceived stress and cervical neoplasia in low-income HIV-infected women.

OBJECTIVE: Risk for developing cervical neoplastic disease is greatly increased in women infected with oncogenic sexually transmitted human papillomaviruses (HPVs) and who have lowered cellular immunity due to coinfection with human immunodeficiency virus (HIV) infection. The majority of these individuals are low-income minority women. Factors associated with promotion of HPV to cervical neoplasia in HIV-infected populations include degree of immunosuppression as well as behavioral factors such as tobacco smoking and psychological stress. This study examined the effects of a cognitive behavioral stress management (CBSM) intervention on life stress and cervical neoplasia in HIV+ minority women. METHODS: Participants were 39 HIV+ African-American, Caribbean, and Hispanic women with a recent history of an abnormal Papanicolaou smear. Participants underwent colposcopic examination, psychosocial interview, and peripheral venous blood draw at study entry and 9 months after being randomly assigned to either a 10-week CBSM group intervention (n=21) or a 1-day CBSM workshop (n=18). RESULTS: Women assigned to the 10-week group-based CBSM intervention reported decreased perceived life stress and had significantly lower odds of cervical neoplasia over a 9-month follow-up. CBSM effects on life stress and neoplasia appeared independent of presence of neoplasia at study entry, HPV type, CD4+CD3+ cell count, HIV viral load, and substance use. Furthermore, CBSM intervention effects on cervical neoplasia were especially pronounced among women with residual life stress at follow-up. CONCLUSION: These findings suggest that stress management decreases perceived life stress and may decrease the odds of cervical neoplasia in women with HIV and a history of abnormal Papanicolaou smears. Although preliminary, these findings suggest the utility of stress management as a cancer prevention strategy in this high-risk population.

Lifestyle factors, body mass index, and lipid profile in adolescents.

OBJECTIVE AND METHODS: A model specifying body mass index (BMI) as mediating the relationship between lifestyle factors (aerobic fitness determined by peak oxygen consumption; physical activity by 7-day physical activity recall; diet by 24 hr dietary recall), and lipid profile were tested in a sample of 205 adolescents (73% boys), who were on average at risk of overweight, aerobically unfit, and from ethnic minority groups. RESULTS: In this well-fitting model, consuming a diet low in fat and cholesterol, and being aerobically fit predicted lower BMI, which together resulted in increases in high-density lipoprotein cholesterol and decreases in triglycerides and low-density lipoprotein cholesterol. Being physically active, predicted greater aerobic fitness. CONCLUSIONS: In addition to furthering understanding of the interrelationships among predisposing, major, and conditional coronary heart disease risk factors in adolescents, these data suggest that improving diet and aerobic fitness will reduce BMI and result in a better lipid profile.

Translation of the Diabetes Prevention Program to Ethnic Communities in the United States.

The Diabetes Prevention Program (DPP), an evidenced-based lifestyle intervention for type 2 diabetes (T2D), has been translated for use with ethnic minority communities throughout the United States that are disproportionately at-risk for T2D. The present paper sought to critically review ethnic translation studies of the DPP with respect to translation methods utilized, the success of these methods, and alternative or supplemental methodologies for future translation efforts. Manuscripts reviewed were found by searching PubMed and PsycINFO, using the terms: "diabetes prevention program" AND ["translation" or "ethnic"]. Of 89 papers found, only 6 described ethnic translations of the DPP in the United States, and were included in this review. Translations of the DPP to African American, Hispanic/Latino, Native Hawaiian and Other Pacific Islander, Arab American, and American Indian and Native Alaskan communities were identified and reviewed. The most common translation strategies included group-based delivery and use of bilingual study personnel. Generally, these factors appeared to increase acceptability of the intervention within the ethnic communities reviewed, and should be considered in future efforts to implement and translate the DPP to ethnic communities in the United States.

Technological and medical advances: implications for health psychology.

Behavioral telehealth, health informatics, organ and tissue transplantation, and genetics are among the areas that have been affected by advances in technology and medicine. These areas illustrate the opportunities and the challenges that new developments can pose to health psychologists. Each area is discussed with respect to implications for practice, research, public policy, and education and training: recommendations are provided.

Cognitive-behavioral stress management and psychological well-being in HIV+ racial/ethnic minority women with human papillomavirus.

OBJECTIVE: This study is a secondary analysis examining the effects of a cognitive-behavioral stress management (CBSM) intervention on indicators of positive psychological well-being and negative psychological well-being in HIV-positive racial/ethnic minority women at risk for cervical cancer due to human papillomavirus (HPV) infection and/or cervical intraepithelial lesions (CIN). METHOD: Racial/ethnic minority women with HIV and HPV and/or CIN I were randomized to a 10-week CBSM group or a 1-day psychoeducational seminar. Participants completed a battery of measures of positive and negative psychological well-being at 3 time points: preintervention, 3 months postenrollment, and 9 months postenrollment. RESULTS: Women in the CBSM group reported significant increases in domains of positive well-being, with no changes among women in the psychoeducational seminar, F(6, 63) = 2.42, p < .05, η² = .19. There were no significant changes in domains of negative well-being across time for either group, F(2, 65) = 2.60, p = .08, η² = .07. CONCLUSION: These findings suggest that racial/ethnic minority women with HIV at risk for cervical cancer who were randomized to a 10-week CBSM group experienced enhanced positive well-being. The lack of effects on negative well-being may be due to the relatively low levels of negative well-being present in this sample at study entry. Future research should examine whether these effects are replicated in a randomized controlled trial of women with biopsy-confirmed CIN who present with greater distress levels that also employs a time-equivalent comparison condition.