Findings from an online behavioural weight management programme provided with or without a fortified diet beverage.

The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact.

The health of women in the US fire service.

BACKGROUND: Despite statements from national fire service organizations, including the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC), promoting a diverse work force related to gender within the fire service, rates of women firefighters remain very low. Thus, research into why this extensive gender disparity continues is a high priority. Recent years have seen a number of large scale studies on firefighter health and health risk behaviors however, none have focused on the health of women firefighters and nearly all have eliminated women from the sample due to small sample size. Data from the present report is drawn from all females in a large, randomly selected cohort of firefighters in an epidemiological study designed to assess health outcomes and health risk behaviors identified as most important to the fire service. METHODS: Data reported for the present study were collected as baseline data for the Firefighter Injury and Risk Evaluation (FIRE) Study, a longitudinal cohort study examining risk factors for injury in both career and volunteer firefighters in the IAFC Missouri Valley Region. Of the departments assessed, only 8 career and 6 volunteer departments had any women firefighters. All the women solicited for participation chose to enroll in the study. The number of women ranged from 1 to 7 in career departments and 1 to 6 in volunteer departments. RESULTS: Where possible, comparisons are made between female firefighters and published data on male firefighters as well as comparisons between female firefighters and military members. Compared to male firefighters, females had more favorable body composition among both career and volunteer firefighters. Tobacco use rates were generally higher among females than males and rates among female firefighters were similar to the rates of female military members. While rates of alcohol use were higher than the general population, only one of the participants evidenced responses in the range of concern on the CAGE screening. CONCLUSIONS: In general, the findings offer an interesting glimpse of the health of women in the fire service as a generally healthy occupational workforce with some unique health risk behavior challenges. They also highlight some of the similarities and differences between male and female firefighters and bolster the argument for studying female firefighters as a unique occupational sub-population.

Tobacco use among firefighters in the central United States.

BACKGROUND: This study provides a comprehensive, population-based examination of tobacco use among both career and volunteer firefighters. METHODS: Data are from a population-based cohort study of randomly selected career (N = 11) and volunteer (N = 13) departments comprised of 677 male firefighters. RESULTS: Unadjusted rates of smoking were 13.6% and 17.4% for career and volunteer firefighters, respectively. Smoking rates were less than a comparable occupational group (military personnel) and adult males in the states represented. Smokers were more likely to have been diagnosed with an anxiety disorder (OR = 5.8; P = 0.010), have an elevated CAGE alcohol problem score (OR = 2.9; P = 0.040), and more likely to report driving after drinking too much (OR = 4.5; P = 0.020) compared to never-smokers. Large percentages of career (18.4%) and volunteer (16.8%) firefighters used smokeless tobacco. CONCLUSIONS Smoking among firefighters is associated with other significant health and safety risks. High rates of smokeless tobacco use suggest that the fire service is an important target for intervention. Thus, despite strong statements against smoking by the fire service, the need to maintain high levels of health and fitness and relatively low smoking rates, a significant proportion of firefighters continue to use tobacco products.

Military tobacco policies: the good, the bad, and the ugly.

The United States military has the legacy of a pro-tobacco culture and still has prevalence rates of tobacco use that are higher than their civilian counterparts. One tactic for decreasing use and the subsequent health problems is through effective tobacco control policies. We collected available tobacco control policies from all four branches of the military and, through qualitative analysis, identified policies that were unique either as providing more or less detail and restriction than peer group policies. Best and worst practice policies in the areas of enforcement, smoking cessation, smokeless tobacco use, environmental tobacco smoke, framing tobacco as non-normative, designated tobacco use areas, and monitoring of tobacco use are presented. Because policy making can be an effective tool for improving the health of military members, understanding what policy components are comparatively positive or negative is an important tool for health advocates both in the military and civilian settings.

The Census of Social Institutions (CSI): a public health direct observation measure of local land use.

This manuscript describes the development of the Census of Social Institutions (CSI), a reliable direct observation parcel-level built environment measure. The CSI was used to measure all non-residential parcels (n = 10,842) in 21 one-mile-radius neighborhoods centered around census block groups of varying income and ethnicity in a large metropolitan area. One year test-retest and inter-rater intra-class correlations showed high reliability for major use type and detail code observations. The CSI accurately captured the presence of about 9,500 uses, including 828 multiple major use and 431 mixed major use parcels that would have been missed in standard commercial databases. CSI data can be utilized to determine the health impacts of environmental settings.

A qualitative analysis of the tobacco control climate in the U.S. military.

INTRODUCTION: Rates of tobacco use in the U.S. military have traditionally been higher than in the general U.S. population. While the military has experienced decreases in tobacco use over the past two decades, recent surveys suggest a trend of increased use. Given the negative impact of tobacco on both the readiness and the long-term health of military members, it is important to understand what factors may be related to the increased use rates. It has been suggested that there is a culture that supports tobacco use in the military. METHODS: We examined perceptions about the climate of tobacco control among military installation Tobacco Control Managers and Service Policy Leaders from all four branches of the military (n = 52) using semistructured interviews. RESULTS: The primary strength of the military's tobacco control program, according to the participants, was mandating the provision of treatment services on every military installation. Any military member can receive both counseling and pharmacotherapy for tobacco. Opinions vary on the most promising new strategies for tobacco control. Many have pushed for a completely tobacco-free Department of Defense, including requiring troops to be tobacco-free and banning tobacco sales on military installations. However, a number of tobacco control experts within the military worry about unintended consequences of a complete ban. DISCUSSION: While several benefits of the current tobacco control program were identified, opportunities for improvement were identified at both the installation and service level.

The use of a commercial vegetable juice as a practical means to increase vegetable intake: a randomized controlled trial.

BACKGROUND: Recommendations for daily dietary vegetable intake were increased in the 2005 USDA Dietary Guidelines as consumption of a diet rich in vegetables has been associated with lower risk of certain chronic health disorders including cardiovascular disease. However, vegetable consumption in the United States has declined over the past decade; consequently, the gap between dietary recommendations and vegetable intake is widening. The primary aim of this study is to determine if drinking vegetable juice is a practical way to help meet daily dietary recommendations for vegetable intake consistent with the 2005 Dietary Guidelines and the Dietary Approaches to Stop Hypertension (DASH) diet. The secondary aim is to assess the effect of a vegetable juice on measures of cardiovascular health. METHODS: We conducted a 12-week, randomized, controlled, parallel-arm study consisting of 3 groups of free-living, healthy volunteers who participated in study visits at the Ragle Human Nutrition Research Center at the University of California, Davis. All subjects received education on the DASH diet and 0, 8 or 16 fluid ounces of vegetable juice daily. Assessments were completed of daily vegetable servings before and after incorporation of vegetable juice and cardiovascular health parameters including blood pressure. RESULTS: Without the juice, vegetable intake in all groups was lower than the 2005 Dietary Guidelines and DASH diet recommendations. The consumption of the vegetable juice helped participants reach recommended intake. In general, parameters associated with cardiovascular health did not change over time. However, in the vegetable juice intervention groups, subjects who were pre-hypertensive at the start of the study showed a significant decrease in blood pressure during the 12-week intervention period. CONCLUSION: Including 1-2 cups of vegetable juice daily was an effective and acceptable way for healthy adults to close the dietary vegetable gap. Increase in daily vegetable intake was associated with a reduction in blood pressure in subjects who were pre-hypertensive at the start of the trial. TRIAL REGISTRATION: Clinicaltrials.gov NCT01161706.

Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial.

BACKGROUND: Metabolic syndrome, a constellation of metabolic risk factors for type 2 diabetes and cardiovascular disease, is one of the fastest growing disease entities in the world. Weight loss is thought to be a key to improving all aspects of metabolic syndrome. Research studies have suggested benefits from diets rich in vegetables and fruits in helping individuals reach and achieve healthy weights. OBJECTIVE: To evaluate the effects of a ready to serve vegetable juice as part of a calorie-appropriate Dietary Approaches to Stop Hypertension (DASH) diet in an ethnically diverse population of people with Metabolic Syndrome on weight loss and their ability to meet vegetable intake recommendations, and on their clinical characteristics of metabolic syndrome (waist circumference, triglycerides, HDL, fasting blood glucose and blood pressure).A secondary goal was to examine the impact of the vegetable juice on associated parameters, including leptin, vascular adhesion markers, and markers of the oxidative defense system and of oxidative stress. METHODS: A prospective 12 week, 3 group (0, 8, or 16 fluid ounces of low sodium vegetable juice) parallel arm randomized controlled trial. Participants were requested to limit their calorie intake to 1600 kcals for women and 1800 kcals for men and were educated on the DASH diet. A total of 81 (22 men & 59 women) participants with Metabolic Syndrome were enrolled into the study. Dietary nutrient and vegetable intake, weight, height, leptin, metabolic syndrome clinical characteristics and related markers of endothelial and cardiovascular health were measured at baseline, 6-, and 12-weeks. RESULTS: There were significant group by time interactions when aggregating both groups consuming vegetable juice (8 or 16 fluid ounces daily). Those consuming juice lost more weight, consumed more Vitamin C, potassium, and dietary vegetables than individuals who were in the group that only received diet counseling (p < 0.05). CONCLUSION: The incorporation of vegetable juice into the daily diet can be a simple and effective way to increase the number of daily vegetable servings. Data from this study also suggest the potential of using a low sodium vegetable juice in conjunction with a calorie restricted diet to aid in weight loss in overweight individuals with metabolic syndrome.

Factors which influence tobacco use among junior enlisted personnel in the United States Army and Air Force: a formative research study.

BACKGROUND: Despite the implementation of a host of tobacco control initiatives, tobacco use among active duty members of the U.S. Military remains high. It has been suggested that a positive culture of tobacco, which drives consumption, exists in the military. However, little is know about factors that impact tobacco use among military personnel. OBJECTIVE: This study provides the first formative data on the culture of tobacco in the U.S. Military. METHODS: A total of 15 focus groups on six military installations were conducted (n = 189). These military installations were located throughout the continental United States and were of average size for each service. RESULTS: Participants suggested that the primary method the military uses to discourage use is tobacco bans. Unfortunately, they also believed that the military accommodates tobacco use so that smoking remains convenient despite the bans on tobacco use. Smoking was believed to be encouraged through liberal smoking breaks, social interaction within designated smoking areas, and cheap and convenient tobacco products sold on military installations. Additionally, smoking was seen as an effective method to combat the stress and boredom of military life and to avoid weight gain. CONCLUSIONS: Suggestions for addressing the culture of tobacco are suggested.

Occupationally Tailored, Web-Based, Nutrition and Physical Activity Program for Firefighters: Cluster Randomized Trial and Weight Outcome.

OBJECTIVE: The aim of this study was to determine the efficacy of an occupationally tailored, web-based health and wellness program, The First Twenty® (TF20), for weight change among volunteer firefighters. METHODS: The impact of TF20 on firefighters' 6-month weight change was tested in a cluster, randomized controlled trial, using a crossover design of firefighters in 10 departments. TF20 has web-based nutrition, physical activity, and behavioral health components. RESULTS: An adjusted treatment-induced weight loss from 1.7 to 2.8 lb was observed for all participants and 2.3 to 3.1 lb among overweight and obese participants. An average weight gain was observed among firefighters in the control condition and weight loss for those in the treatment condition. CONCLUSIONS: TF20 supports firefighters' weight loss. Firefighters need wellness interventions to improve nutrition and physical activity given their high prevalence of obesity.

Weight management using the internet a randomized controlled trial.

BACKGROUND: Most weight-loss research targets obese individuals who desire large weight reductions. However, evaluation of weight-gain prevention in overweight individuals is also critical as most Americans become obese as a result of a gradual gain of 1-2 pounds per year over many years. METHOD: This study evaluated the efficacy of an Internet-based program for weight-loss and weight-gain prevention with a two-group, prospective, randomized controlled trial. A military medical research center with a population of 17,000 active-duty military personnel supplied 446 overweight individuals (222 men; 224 women) with a mean age of 34 years and a mean BMI of 29. Recruitment and study participation occurred 2003-2005 and data were analyzed in 2006. Participants were randomly assigned to receive the 6-month behavioral Internet treatment (BIT, n=227) or usual care (n=224). Change in body weight, BMI, percent body fat, and waist circumference; presented as group by time interactions, were measured. RESULTS: After 6 months, completers who received BIT lost 1.3 kg while those assigned to usual care gained 0.6 kg (F((df=366))=24.17; I<0.001). Results were similar for the intention-to-treat model. BIT participants also had significant changes in BMI (-0.5 vs +0.2 kg/m(2); F((df=366))=24.58); percent body fat (-0.4 vs +0.6%; F((df=366))=10.45); and waist circumference (-2.1 vs -0.4 cm; F((df=366))=17.09); p<0.001 for all. CONCLUSIONS: Internet-based weight-management interventions result in small amounts of weight loss, prevent weight gain, and have potential for widespread dissemination as a population health approach. TRIAL REGISTRATION: NCT00417599.

The pediatric residency training on tobacco project: four-year parent outcome findings.

OBJECTIVE: To assess parent behavioral change and perception of resident intervention on tobacco. METHODS: In a long-term study of the efficacy of training pediatric residents to address tobacco conducted at the New Jersey Medical School, sixteen pediatric training programs were assigned randomly to either special or standard training conditions. Parent surveys were administered in the fall of 2001 and 2005 in order to assess the effects of resident intervention on parent behavior, as well as parent perceptions of resident intervention. RESULTS: The percent of parents who smoke at sites associated with the special training condition, but not of those at sites associated with standard training, who reported that residents advised them to stop smoking, offered to help them quit, and provided quit smoking materials increased significantly from baseline to year 4. The percent of parents in the special training condition who reported quitting smoking in the past year also increased, although the increase was not statistically significant. A majority of the parents associated with each training condition reported receiving intervention for second hand smoke (SHS). For each training condition, the level of intervention to prevent exposure of infants and children to SHS exposure was similar at baseline and year 4, as was the percent of parents who reported having a smoke-free household. CONCLUSION: The results support the efficacy of the special training program and underscore the importance of preparing pediatric residents to address tobacco.

Demographics and risky lifestyle behaviors associated with willingness to risk sexually transmitted infection in Air Force recruits.

PURPOSE: To investigate sexually transmitted infection (STI) risk-taking behaviors relative to other lifestyle and risk-taking behaviors. DESIGN: The study design is cross sectional. SETTING: Lackland Air Force Base in San Antonio, Texas. SUBJECTS: Participants (N = 32,144) were 100% of Air Force recruits beginning basic military training from August 1995 to August 1996. MEASURES: Recruits completed a questionnaire that included rating the statement "Sex without condoms is sometimes worth the risk of possibly getting AIDS or sexually transmitted diseases." Risky behaviors, such as risk taking, rebelliousness, seat belt use, smoking, alcohol use and binge drinking, opinions of illicit drug use, and lifestyle behaviors, such as dietary intake and physical activity, were also assessed. ANALYSIS: Univariate and multivariate logistic regression analyses examined the relationships between participant characteristics and willingness to risk STI. RESULTS: Sixteen percent stated willingness to risk STI to have sex without a condom. Women and white/non-Hispanic participants were less likely to agree with the statement than men and minority participants. Those who reported willingness toward risky sexual behaviors were less likely to use seat belts, were more likely to binge drink, had more positive views of illicit drugs, and reported eating fewer fruits and vegetables. CONCLUSION: Results of this study suggest the importance of continued education on condom use and the possibility that multiple risk behavior interventions include sexual risk components.

How does the built environment relate to body mass index and obesity prevalence among public housing residents?

PURPOSE: This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. DESIGN: Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. SETTING: Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800-m radius from center of housing development). SUBJECTS: Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. MEASURES: Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of physical activity resources. Neighborhood street connectivity was also measured. RESULTS: Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p = .05) and between obesity prevalence and resource accessibility (p = .09), number of amenities (p = .04), and amenity quality (p = .04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71% of obesity variance (p < .05). Male gender and higher feature quality, F(11, 407) 37.19 and 12.66, p < .001, predicted lower BMI among residents. CONDUSION: Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.

Prevalence of alternative forms of tobacco use in a population of young adult military recruits.

Recent evidence suggests that the popularity of certain alternative forms of tobacco may be increasing in adolescents. Little is known, however, about the use of these products among young adults. This study examined the use of alternative tobacco products including bidis, cigars, kreteks (clove cigarettes), pipes, and smokeless tobacco in a large sample of young adult military recruits (N=31107). Overall, 18.5% of participants were using some form of alternative tobacco product prior to entry into Basic Military Training. Results revealed a relatively high prevalence of cigar (12.3%) and smokeless tobacco use (6.7%). Use of other products was less common, including 1.1% for pipes, 2.0% for bidis, and 3.0% for kreteks. With the exception of kreteks, which did not differ by gender, the prevalence of use of alternative tobacco products was greater for males than for females (p<.001). Patterns of use also differed according to other demographic characteristics including race, ethnicity, age, and income. Implications for surveillance and tobacco control efforts are discussed.

Reported stress and its relationship to tobacco use among U.S. military personnel.

In addition to common stressors, members of the U.S. Armed Forces experience a high level of stress unique to their status as service members. In an effort to combat stress, many military personnel report high levels of nicotine use. This study investigated the relationship between tobacco use and perceived stress among military members in all four armed services. Results indicate that those who use tobacco products specifically to reduce stress report significantly higher stress levels than those who do not use tobacco. Moreover, current users and those who both smoked and used smokeless tobacco were far more likely to report experiencing "a lot" of stress from a variety of sources than former or never users. Tobacco users also engaged more frequently in negative coping behaviors and relied less on the positive coping strategies used more often by former or never smokers. These findings are consistent with the larger body of literature suggesting that tobacco is not only an ineffective stress-reducing strategy, it also likely perpetuates a stress response in users. It is, therefore, critical that the military improve effective means of coping among nicotine-using troops.

Smoking and deployment: perspectives of junior-enlisted U.S. Air Force and U.S. Army personnel and their supervisors.

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers. We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior-enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges; (3) the perception that dangers in the field trumps the health impact of smoking; and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed.

Obesity classification in military personnel: a comparison of body fat, waist circumference, and body mass index measurements.

OBJECTIVE: The purpose of this study was to evaluate obesity classifications from body fat percentage (BF%), body mass index (BMI), and waist circumference (WC). METHODS: A total of 451 overweight/obese active duty military personnel completed all three assessments. RESULTS: Most were obese (men, 81%; women, 98%) using National Institutes of Health (NIH) BF% standards (men, >25%; women, >30%). Using the higher World Health Organization (WHO) BF >35% standard, 86% of women were obese. BMI (55.5% and 51.4%) and WC (21.4% and 31.9%) obesity rates were substantially lower for men and women, respectively (p < 0.05). BMI/WC were accurate discriminators for BF% obesity (theta for all comparisons >0.75, p < 0.001). Optimal cutoff points were lower than NIH/WHO standards; WC = 100 cm and BMI = 29 maximized sensitivity and specificity for men, and WC = 79 cm and BMI = 25.5 (NIH) or WC = 83 cm and BMI = 26 (WHO) maximized sensitivity and specificity for women. CONCLUSIONS: Both WC and BMI measures had high rates of false negatives compared to BF%. However, at a population level, WC/BMI are useful obesity measures, demonstrating fair-to-high discriminatory power.

The relationship between smoking, BMI, physical activity, and dietary intake among Thai adults in central Thailand.

OBJECTIVE: Evaluate dietary intake, physical activity, and BMI in adult Thais stratified by smoking status, living in the central region of Thailand. MATERIAL AND METHOD: Participants (n = 1,027) were administered a health questionnaires, 24-h dietary recall, and anthropometric measurements were obtained. RESULTS: Compared to ex-smokers (24.5 +/- 4.3 kg/m2) and non-smokers (24.8 +/- 4.0 kg/m2), current smokers (22.6 +/- 3.8 kg/m2) had significantly lower BMIs, regardless of gender (p < 0.001). In addition, male smokers had smaller waist circumferences than non-smokers. There were no statistically significant differences in nutrient intake or physical activity based on smoking status. Results from this study are consistent with others reports showing that smoking is associated with lower weights and BMI when compared to non-smokers. The mechanism for this association may be related to the potential for nicotine to increase metabolic rate rather than appetite suppression in smokers. CONCLUSION: Because the substantial negative health consequences of smoking are far stronger than those associated with modest weight differences, smoking cannot be viewed as an appropriate weight management strategy.

Tissue n-3 and n-6 fatty acids and risk for coronary heart disease events.

BACKGROUND: Tissue proportions of long chain n-6 [especially arachidonic acid (AA)] and n-3 fatty acids [FA; eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) acids], or some ratio of these may be markers of risk for coronary heart disease (CHD). The purpose of this paper is to evaluate the published associations between risk for CHD events and tissue n-3 and n-6 FA composition. METHODS: Case-control or prospective cohort data sets examining the risk for CHD endpoints as a function of tissue FA composition were identified. Effect sizes were computed for case versus control comparisons using standard meta-analytic methods. RESULTS: Twenty-five studies were included, 18 examining the FA composition of phospholipid-rich and 7 of triglyceride-rich samples. DHA, with or without EPA, was significantly lower in cases than controls in all studies combined, in those with fatal endpoints, in those with prospective designs, and in both tissue types. The only setting where increased AA was associated with case status was in adipose tissue. The AA/EPA ratio in phospholipid-rich samples did not distinguish cases from controls. Lower linoleic acid content was associated with increased risk for non-fatal events. CONCLUSIONS: The long-chain n-3 FA, especially DHA, were consistently and significantly reduced in patients experiencing CHD events. These findings add further support to the view that long-chain n-3 FA are cardioprotective.