The theory of planned behavior and dietary behaviors in competitive women bodybuilders.

BACKGROUND: Women bodybuilders build their ideal physique by manipulating their diet, supplement, and exercise regimens to extreme levels. Excess protein intake and dietary supplement use is ubiquitous in women bodybuilders preparing for a competition, i.e., in-season competitors, however the impetus for these two dietary behaviors are relatively unknown. The Theory of Planned Behavior (TPB) has been used to explain dietary behaviors. The purpose of the study was to examine how the TPB can explain protein intake and dietary supplement use in in-season competitors. METHODS: Using a cross-sectional design, an online questionnaire was developed, validated, and administered to collect dietary supplement use, TPB variables, and other measures from 112 in-season competitors. Protein intake was assessed using multiple 24-h dietary recalls. Associations between TPB and protein intake and dietary supplement use were determined with multiple regression analysis while adjusting for confounders. RESULTS: For protein intake: attitude, subjective norm, and perceived behavioral control explained 8% of the variance in intention; subjective norm independently predicted intention. Behavioral beliefs predicted attitude; subjective norm was predicted by trainer/coach, workout partners, and social media influencers. For dietary supplement use: intention explained 5% of the variance in dietary supplement use; attitude, subjective norm, and perceived behavioral control together explained 38% of the variance in intention. Attitudes towards dietary supplements use were predicted by five factors (not a waste of money, help improve physique, sustain energy levels, provide enough calories, help with recovery). Primary determinants of subjective norm were fellow competitors, social media influencers, and trainer/coach. Perceived behavioral control was predicted by three factors (ease of purchase, affordability to purchase, availability to purchase). CONCLUSIONS: TPB predicted dietary supplement use in women bodybuilders during in-season but there was little evidence for the prediction of protein intake using the TPB. Health professionals should develop effective interventions using strategies that align health education messages with in-season competitors' outcome beliefs and collaborate with their referent others to influence safer and effective dietary supplement use.

Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort.

INTRODUCTION: Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) - the largest maternal tobacco cessation program in San Bernardino County, California - to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. METHODS: During 2012-2019, women who smoked during pregnancy were enrolled in CTTP's multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). RESULTS: We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. DISCUSSION: Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program.

Social-Ecological Correlates of Loneliness Among Young Adult U.S. Males.

PURPOSE: Social disconnection, such as loneliness, is recognized as a significant public health concern in the United States, and young adult males may carry the greater burden of this issue when compared with their female peers. Little is known about the correlates of loneliness for this population. This study examines the social-ecological correlates of loneliness in young adult males. METHODS: Males, aged 18 to 25 years, in the United States were recruited to take part in a cross-sectional electronic survey. Loneliness was assessed as a composite measure. The social-ecological correlates consisted of intrapersonal-level (e.g., social-demographic characteristics), interpersonal-level (e.g., adverse childhood experiences), community-level (e.g., life expectancy at the county level), and societal-level (e.g., idealized masculine gender) variables. A four-block hierarchical regression was performed with each block representing the respective social-ecological level. RESULTS: Among the study sample (n = 495), the intra- and interpersonal variables significantly shared 10% and an incremental 3%, respectively, of the explained variance in loneliness. Mental health diagnosis (ß = 1.06, 95% confidence interval [CI]: [0.54, 1.59]), childhood physical and emotional abuse (ß = 0.21, 95% CI: [0.02, 0.39]), and childhood sexual abuse (ß = 0.30, 95% CI: [0.01, 0.60]) were significantly associated with greater loneliness. CONCLUSION: The findings highlight that the micro-level (intra- and interpersonal) correlates may be most important in predicting loneliness in young adult males. Specifically, young males with a mental health diagnosis and those with greater experiences of childhood adversity are at potentially greater risk for loneliness. Implications for research, programming, and policy are highlighted.

Working Together with God: Religious Coping, Perceived Discrimination, and Hypertension.

This study examined the relationships of perceived discrimination and religious coping with hypertension in a sample of Black and White Seventh-day Adventists. Data come from a community-based sample of 6128 White American, 2253 African American and 927 Caribbean American adults (67% women; mean age = 62.9 years). Results indicate lifetime unfair treatment was significantly associated with hypertension regardless of race/ethnicity. Positive religious coping was associated with lower odds of hypertension and did not interact with unfair treatment. Both positive and negative religious coping were indirectly associated with increased hypertension risk through an increase in perceived discrimination.

The Association between Affect and Biomarkers of Stress and Inflammation in Healthy Seventh-Day Adventists.

OBJECTIVE: To evaluate the association between positive and negative affective states with stress biomarkers, biomarkers of inflammation and blood pressure in a population of healthy Seventh-day Adventists. DESIGN: In a cross-sectional study, biomarkers were regressed on positive and negative affect and control variables among reportedly healthy 133 females and 100 males (35% Black and 65% White) who provided blood and urine samples following completion of a questionnaire and measurement of anthropometrics and vital signs. SETTING/LOCATION: Data were extracted from the Biological Manifestations of Religion Study, an NIA-funded study conducted in members of the entity who lived within driving distance of two clinic sites. OUTCOME MEASURES: The stress biomarkers, epinephrine, and norepinephrine, were measured in 12-hour overnight urine samples analyzed by high-performance liquid chromatography. Urinary cortisol was evaluated by enzyme-linked immunosorbent assay (ELISA) and normalized for urinary output (reported in µg/g creatinine). Serum DHEA-S (reported in µg/ml) was measured by ELISA. Inflammatory markers included CRP (ng/ml), IL-6, IL-10, and TNF-α, all analyzed in serum by ELISA, and the data expressed in pg/ml. RESULTS: Multiple linear regression analyses showed after controlling for age, gender, ethnicity, body mass index (BMI), education, socioeconomic status, exercise, and use of blood pressure medication, that negative affect was associated with higher levels of epinephrine (ß = .143; P = .030). Positive affect was not associated with the biomarkers. CONCLUSIONS: While negative affect was associated with a biomarker of sympathetic stimulation, positive affect was not protective against such stimulation.

Burden of Hearing Loss on Communication Partners and Its Influence on Pursuit of Hearing Evaluation.

OBJECTIVE: Describe how the burden on the communication partner (CP) from the patient's hearing loss, as perceived by both the patient and their CP, influences a patient's pursuit of hearing evaluation. DESIGN: Cross-sectional design. Demographics, perception of patient's hearing loss, and associated burden on the CP were collected from both patient and CP via online questionnaires. Patients and their CPs from Duke University Medical Center Otolaryngology Clinic, 55 to 75 years of age, being seen for any reason, who indicated a CP has expressed concern about their hearing. Final sample was 245 matched pairs. RESULTS: Based on completed questionnaires, on average, patients perceived their own hearing loss as more burdensome to the CP than the CP did. However, CPs of patients who believed themselves to have no hearing handicap scored the patient's hearing loss 54.3% higher than the patient. The patient's perspective about the amount of burden their hearing loss placed on the CP predicted patients seeking a hearing evaluation. CONCLUSIONS: Recognition of early stage hearing loss and associated burden on CPs may be delayed in patients; CPs may help elucidate unrecognized concerns. Educational approaches that raise awareness of burden of hearing loss on CPs along with hearing loss indications could be a feasible, multidimensional strategy to promote help seeking behaviors.

Intrinsic Religiosity and Hypertension Among Older North American Seventh-Day Adventists.

A unique lifestyle based on religious beliefs has been associated with longevity among North American Seventh-day Adventists (SDAs); however, little is known about how religion is directly associated with hypertension in this group. Identifying and understanding the relationship between hypertension and its predictors is important because hypertension is responsible for half of all cardiovascular-related deaths and one in every seven deaths in the USA. The relationship between intrinsic religiosity and hypertension is examined. Cross-sectional data from the Biopsychosocial Religion and Health Study (N = 9581) were used. The relationship between intrinsic religiosity and hypertension when controlling for demographics, lifestyle variables, and church attendance was examined using binary logistic regression. While lifestyle factors such as vegetarian diet and regular exercise were important predictors of reduced rates of hypertension, even after controlling for these, intrinsic religiosity was just as strongly related to lower hypertension rates as the lifestyle factors. This study is the first to examine the relationship between intrinsic religiosity and hypertension among North American SDAs and demonstrates that in addition to the positive effects of lifestyle choices on health noted in the group, religion may offer direct salutary effects on hypertension. This finding is particularly important because it suggests that religiosity and not just lifestyle is related to lower risk of hypertension, a leading cause of death in the USA.

Religious Social Support and Hypertension Among Older North American Seventh-Day Adventists.

Seventh-day Adventists have been noted for their unique lifestyle, religious practices and longevity. However, we know little about how religion is directly related to health in this group. Specifically, we know nothing about how religious social support is related to hypertension. Using data from the Biopsychosocial Religion and Health Study, we carried out a cross-sectional study of 9581 and a prospective study of 5720 North American Seventh-day Adventists examining new 534 cases of hypertension occurring up to 4 years later. We used binary logistic regression analyses to examine study hypotheses. Of the religious social support variables, in both the cross-sectional and prospective study only anticipated support significantly predicted hypertension, but the relationship was mediated by BMI. There were no significant race or gender differences. The favorable relationships between anticipated support and hypertension appear to be mediated by BMI and are an indication of how this dimension of religion combined with lifestyle promotes good health, specifically, reduced risk of hypertension.

Association of TV watching with sleep problems in a church-going population.

Sensory stimuli/inactivity may affect sleep. Sleep problems are associated with multiple health problems. We assessed TV habits in the Adventist Health Study-2 at baseline and sleep problems in the Biopsychosocial Religion and Health Study 1 to 4 years later. After exclusions, 3914 subjects split equally into TV watchers less than 2 hours per day or 2 or more hours per day. Watching TV 2 or more hours per day predicted problems falling asleep, middle of the night awakening, and waking early with inability to sleep again in multiple logistic regression. Excess TV watching disturbed sleep induction and quality, though the relationship may be bidirectional. TV habits should be considered in individuals with sleep problems.

Autonomy and social norms in a three factor grief model predicting perinatal grief in India.

Perinatal grief following stillbirth is a significant social and mental health burden. We examined associations among the following latent variables: autonomy, social norms, self-despair, strained coping, and acute grief-among poor, rural women in India who experienced stillbirth. A structural equation model was built and tested using quantitative data from 347 women of reproductive age in Chhattisgarh. Maternal acceptance of traditional social norms worsens self-despair and strained coping, and increases the autonomy granted to women. Greater autonomy increases acute grief. Greater despair and acute grief increase strained coping. Social and cultural factors were found to predict perinatal grief in India.

Effects of an online support group for prostate cancer survivors: a randomized trial.

This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life. Participants (N = 40) were randomly assigned to an online support group or the control group. Data consisted of four previously validated quality-of-life measurements. Analysis determined that over time, quality of life improved for those in the online group and decreased for those in the control group, but returned to baseline at eight weeks. Providing support using online methods is effective; the length of time this intervention should be provided to patients will require further research.

Dietary Intake and Supplement Use in Competitive Women Bodybuilders.

(1) Background: Women bodybuilders use extreme diets, dietary supplementation, and training regimes to sculpt their physiques. Women's participation in bodybuilding competitions has increased since the 1980s. Currently, studies on their dietary intake and supplement use are limited. Their dietary intake may be of poor quality and low in several micronutrients, while supplement use appears to be omnipresent. Thus, the aim of this study was to examine and compare the dietary intake, supplement use, and diet quality of in-season and off-season women bodybuilders. (2) Methods: In a cross-sectional design, we compared dietary intake, supplement use, and diet quality between seasons in women bodybuilders (n = 227). An online questionnaire was developed, validated, and administered to assess all non-dietary and supplement variables. The Automated Self-Administered 24 h Dietary Assessment Tool was used to collect four 24 h dietary recalls. The Healthy Eating Index-2015 (HEI-2015) was used to calculate diet quality. The analysis of covariance and Welch's t-tests were used to assess the differences between in-season and off-season women bodybuilders' dietary intake, supplement, and HEI-2015 variables. (3) Results: In-season competitors reported consuming significantly less energy, carbohydrates, and fat but more protein than off-season competitors. All competitors consumed excess protein, while in-season competitors consumed excess fat and off-season competitors consumed less energy than the physique athlete nutrition recommendations. All competitors' micronutrient intakes were above the Dietary Reference Intakes. Supplements were used by all competitors, and the mean number used was similar between seasons. The HEI-2015 scores were not significantly different between seasons yet were below the US Dietary Guidelines for Americans. (4) Conclusion: Women bodybuilders would benefit from health education to achieve physique athlete nutrition recommendations, improve diet quality, and safe/efficacious supplement use to reach physique goals and improve overall health.

Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

Social-Ecological Correlates of Social Isolation as a Structural Indicator of Social Connectedness Among Young Adult U.S. Males.

PURPOSE: We examined the intrapersonal, interpersonal, community, and societal correlates of a structural indicator of social connectedness (ie, social isolation) among a sample of young adult U.S. males. DESIGN: Cross-sectional. Setting: Online survey. SUBJECTS: Males (n = 495) aged 18-25 years residing in the U.S. MEASURES: Social isolation was assessed as an index measure of social integration (inverse scored). The correlates consisted of the following variables: 1) intrapersonal (eg, social-demographic characteristics), 2) interpersonal (eg, adverse childhood experiences; marital status), 3) community (eg, county-level mental distress rates), and 4) societal (eg, how powerful is society's image of the 'masculine man'). ANALYSIS: Four-block hierarchical regression. RESULTS: The intra- and interpersonal variables significantly shared 17% and an incremental 5%, respectively, of the explained variance in social isolation. Several intra- (eg, financial vulnerability ß = -2.76, [95% CI: -4.40, -1.13]) and inter-personal (ie, childhood household dysfunction ß = -.66, [95% CI: -1.18, -.14]) factors were significantly associated with greater social isolation. Four intrapersonal factors (eg, gay or bisexual ß = 2.31, [95% CI: .29, 4.33]) were significantly associated with lower social isolation. CONCLUSIONS: The current study's findings have important implications for understanding and shaping social connectedness in young adult U.S. males, with micro-level influences potentially being most important in predicting social isolation in this population.

Determinants of inflammatory markers in a bi-ethnic population.

BACKGROUND: Inflammation is a common pathophysiological pathway for a number of chronic diseases, and is strongly influenced by sociodemographic factors and lifestyle. Less is known about factors that may influence the inflammatory response in individuals of distinct ethnic backgrounds. Therefore, this study examined the relationship between ethnicity and blood levels of inflammatory markers in a sample of non-smoking church-goers. METHODS: In a cross-sectional investigation, 508 men and women (> 35 years old, 62% White, 38% Black) participated in the Biopsychosocial Religion and Health substudy of the Adventist Health Study 2. The contribution of socioeconomic status (education level and difficulty meeting expenses for basic needs) and health covariates (exercise, vegetarian or other type of diet, body mass index, and presence of inflammatory conditions) toward serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) was assessed with linear regression models. Levels of interleukin-10 (IL-10), an anti-inflammatory marker, were also assessed. RESULTS: Blacks showed higher levels of CRP and IL-6 than Whites. Controlling for sociodemographic and health variables attenuated the ethnic difference in CRP while IL-6 levels remained higher in Blacks than in Whites (beta = .118; 95% confidence interval = .014-.206; P = .025). Ethnic differences in IL-10 and TNF-alpha were not found. Vegetarian diet was associated with lower CRP levels while exercise frequency was associated with higher IL-10 levels. CONCLUSION: Higher susceptibility of Blacks to inflammatory diseases may reflect higher IL-6, which could be important in assessing health disparities among Blacks and Whites. Vegetarian diet and exercise may counteract effects of disparities.

Clarifying and measuring filial concepts across five cultural groups.

Literature on responsibility of adult children for aging parents reflects lack of conceptual clarity. We examined filial concepts across five cultural groups: African-, Asian-, Euro-, Latino-, and Native Americans. Data were randomly divided for scale development (n = 285) and cross-validation (n = 284). Exploratory factor analysis on 59 items identified three filial concepts: Responsibility, Respect, and Care. Confirmatory factor analysis on a 12-item final scale showed data fit the three-factor model better than a single factor solution despite substantial correlations between the factors (.82, .82 for Care with Responsibility and Respect, and .74 for Responsibility with Respect). The scale can be used in cross-cultural research to test hypotheses that predict associations among filial values, filial caregiving, and caregiver health outcomes.

Development of a caregiver empowerment model to promote positive outcomes.

Family members caring for aging parents experience both negative and positive outcomes from providing care. Theoretical explanations for negative outcomes have been developed. There is need for models that explain and predict positive outcomes. This article describes the evolution of the Caregiver Empowerment Model (CEM) to explain and predict positive outcomes of family caregiving. Although empirical findings support positive outcomes of family caregiving, less attention has been given to theoretical rationale for positive effects. The CEM predicts that, in the presence of filial values and certain background variables, caregiving demands are appraised as challenges instead of stressors. Appraising caregiving demands as a challenge, finding meaning, and using certain types of coping strategies are posited to be associated with growth and well-being. The CEM extends our understanding of the complexity of the caregiving experience, and can serve as a framework to guide in developing and testing theory-based interventions to promote positive outcomes.

Implications of Tamarkoz on stress, emotion, spirituality and heart rate.

Perceived stress among university students is a prevalent health issue directly correlated with poor academic performance, poor sleep quality, hopelessness, compromised physical and mental health, high risk of substance abuse, and suicidal ideation. Tamarkoz, a Sufi meditation, may reduce the impact of stressors to prevent illness among students. Tamarkoz is the art of self-knowledge through concentration and meditation. It is a method of concentration that can be applied to any task. The method is said to discipline the mind, body, and emotions to avoid unintended distractions. Therefore, it can be used in daily life activities, such as studying, eating, driving, de-stressing or in Sufism, seeking self-knowledge. This study was an 18-week quasi-experimental design with pre-intervention, post-intervention and follow-up assessments in the experimental group, a wait-list control, and a third group that utilized the campus health center's stress management resources. Participants, university students, had no prior exposure to Tamarkoz, and there were no statistically significant differences among groups on baseline measurements. Using a generalized linear mixed model, significant increases in positive emotions and daily spiritual experiences, and reductions in perceived stress and heart rate were found in the experimental group compared to the other two groups. Tamarkoz seems to show some advantages over the usual stress management resources offered by a student health center.Trial registration: ClinicalTrials.gov Protocol Registration Date: (03/04/2018); ClinicalTrials.gov ID: NCT03489148.

Exercise, Flourishing, and the Positivity Ratio in Seventh-Day Adventists: A Prospective Study.

PURPOSE: Flourishing and mental health in the prediction of health behaviors such as exercise has been understudied. Positive emotions may promote, and negative emotions hinder protective health behaviors; however, the direction of these associations is unclear. The objective here was to investigate possible associations prospectively. DESIGN: Longitudinal cohort study. SETTING: National. SAMPLE: The Biopsychosocial Religion and Health Study of Seventh-day Adventists provided longitudinal data from 2006 to 2007 and 2010 to 2011 (n = 5789). MEASURES: Flourishing was based on 6 measures of social functioning (positive social exchanges, negative social exchanges, religious emotional support given, received, and anticipated, and negative interactions) and 4 measures of psychological functioning (mastery, self-esteem, spiritual meaning, and perceived stress). The positivity ratio was the ratio of positive to negative emotions assessed with the Positive and Negative Affect Schedule. ANALYSIS: Linear multiple regression and mediation. RESULTS: Flourishing worked indirectly through the positivity ratio to predict a later increase in exercise over the course of 3 to 5 years. Tests of mediation suggest that the association of flourishing with later exercise was indirect through an increased ratio of positive to negative affect. Initial exercise frequency was also associated with later improved flourishing and positivity ratio scores over the same period. CONCLUSION: The association of mental health and exercise is likely bidirectional. Exercise improves mental health, and those that have better psychosocial functioning have better mood and are more likely to increase exercise behaviors over time. Exercise is likely integral to mental health in mid to late life.

Plant-based dietary intake moderates adverse childhood experiences association with early mortality in an older Adventist cohort.

BACKGROUND: Adverse Childhood Experiences (ACEs) consistently predict poor mental and physical health as well as early all-cause mortality. Much work examines health harming behaviors that may be used to cope with ACEs associated stress responses and dysregulation. Limited research has been conducted assessing plant-based dietary intake on the ACEs and mortality relationship. We investigate moderators of the ACEs and mortality association including plant-based dietary intake. OBJECTIVE: The purpose of this study is to examine if the association between ACEs and early mortality is potentially moderated by plant-based dietary intake. PARTICIPANTS: An observational, prospective cohort study that included 9301 Seventh-day Adventists were assessed from 2006 to 2017 in the Biopsychosocial Religion and Health Study (BRHS). METHODS: We examined the potential impact of plant-based intake frequency on the ACEs and all-cause mortality relationship, while adjusting for potential confounders (e.g., demographics, health risks, mental and physical health) in a cox regression survival analysis. RESULTS: ACEs were adversely associated with survival time (HR = 2.76, 95% CI: 1.15-6.64). Plant-based intake was associated with a reduction in the association of 4+ ACEs with early mortality (HR = 0.73, 95% CI: 0.59-0.90) above and beyond demographics, animal-based intake, physical health, mental health, BMI, exercise, and worship. We estimate that after 4+ ACEs, those eating high versus low plant-based dietary intake may live 5.4 years longer. CONCLUSION: Plant-based dietary intake may potentially moderate the ACEs and early mortality relationship; however, observational studies cannot determine causality.