Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model.

BACKGROUND: Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity. METHOD: We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression. RESULTS: Women in MMT showed significant reductions in perceived stress (ß = - 0.16) and depressive symptoms (ß = - 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (ß = 0.26) and had lower glucose post-oral glucose tolerance test (ß = - 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group. CONCLUSION: A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.

Novel Interventions to Reduce Stress and Overeating in Overweight Pregnant Women: A Feasibility Study.

Background High stress and depression during pregnancy are risk factors for worsened health trajectories for both mother and offspring. This is also true for pre-pregnancy obesity and excessive gestational weight gain. Reducing stress and depression may be one path to prevent excessive caloric intake and gestational weight gain. Study Purpose We tested the feasibility of two novel interventions aimed at reducing stress and overeating during pregnancy. Reflecting different theoretical underpinnings, the interventions target different mechanisms. Mindful Moms Training (MMT) uses mindfulness to improve awareness and acceptance of experiences and promote conscious rather than automatic behavior choices. Emotional Brain Training (EBT) uses active coping to change perceptions of negative experience and promote positive affective states. Methods Forty-six overweight/obese low-income women were assigned to either MMT (n = 24) or EBT (n = 22) for an 8-week feasibility study. Pre-post changes in perceived stress, eating and presumed mechanisms were assessed. Results Women reported high levels of stress at baseline. Both interventions were well attended and demonstrated clinically significant pre-post reductions in stress, depressive symptoms, and improved eating behaviors. MMT significantly decreased experiential avoidance, whereas EBT significantly increased positive reappraisal; these changes were marginally significantly different by group. Conclusions This feasibility study found that both interventions promoted meaningful reductions in stress and depressive symptoms and improved reported eating behaviors in a high-risk group of pregnant women. Each intervention has a potentially different pathway-acceptance for MMT and reappraisal for EBT. Larger studies are needed to test efficacy on longer term reductions in stress and overeating.

'I would if I could': how oncologists and oncology nurses address spiritual distress in cancer patients.

Medical providers are called upon to address a wide range of psychosocial issues, under increasing time constraints. Spiritual/existential distress was one of 18 issues covered in a survey of oncologists' (n=94) and oncology nurses' (n=267) attitudes and practices regarding psychosocial issues. The survey included patient vignettes at good, moderate and poor prognosis levels, and questions regarding attitudes toward patient care, typical and ideal services, and expectation for impact. A substantial proportion of both oncologists (37.5%) and nurses (47.5%) identified themselves as primarily responsible for addressing spiritual distress in their setting. However, over 85% of both MDs and RNs felt that ideally a chaplain should address such issues. Working in an inpatient setting predicted that nurses, but not doctors, would confer with chaplains. When ranking spiritual distress as important to address in comparison to 17 other issues, only 11.8% of MDs and 8.5% of RNs ranked it in the top three for the poor prognosis vignette, with yet lower values with better prognoses. For the poor prognosis, younger MDs were more likely to address spirituality (r=-0.26) and were also more likely to address anxiety or depression (r=0.25) and family distress (r=0.20). For RNs, no such relationships appeared. Perceived impact was also a predictor of whether spirituality issues were addressed. These results suggest that spiritual distress experienced by cancer patients may be under-addressed due to time constraints, lack of confidence in effectiveness, and role uncertainty.

Antidepressant pharmacotherapy helps some cigarette smokers more than others.

Adult smokers (N = 253) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine (30 or 60 mg daily) or a placebo for 10 weeks in combination with cognitive-behavioral therapy (CBT). It was predicted that fluoxetine would selectively benefit smokers with higher baseline depression, nicotine dependence, and weight concern and lower self-efficacy about quitting smoking. Among those who completed the prescribed treatment regimen, baseline depression scores moderated the treatment response. Logistic regression analyses showed that 1 and 3 months after the quit date, fluoxetine increased the likelihood of abstinence, as compared with placebo, among smokers with minor depression but not among those with little or no depression. Results suggests that, as an adjunct to CBT, fluoxetine enhances cessation by selectively benefiting medication-compliant smokers who display even subclinical levels of depression.

Chart reminders increase referrals for inpatient smoking cessation intervention.

The purpose of this study was to test the effect of a chart reminder system on referral of inpatients to a hospital smoking cessation intervention pilot program. An A1-B-A2 reversal design was used to test the hypothesis that a chart reminder to nursing staff would increase the proportion of smokers referred for smoking cessation intervention over the usual method of posted memos. In Condition A1, memos reminding nursing staff to refer smokers were posted prominently on a cardiopulmonary unit for 4 weeks. In Condition B, a reminder containing the same message was placed in the front of every patient chart for 4 weeks. Finally, in Condition A2, chart reminders were removed and posted memos were reinstated for 4 additional weeks. During Condition A1 (posted memo), only one patient out of 29 eligible smokers was referred, for a referral rate of 3.4%. In Condition B (chart reminders), 18 patients out of 52 (34.6%) were referred (chi 2 = 10.07, p < 0.01). In Condition A2, the referral rate returned to below baseline (2.1%) (chi 2 = 16.80, p < 0.001). The findings support the use of a chart reminder system for screening and referral as an important component for comprehensive smoking cessation programs in the acute care setting.

An Exploratory Study of a Meditation-based Intervention for Binge Eating Disorder.

The efficacy of a 6-week meditation-based group intervention for Binge Eating Disorder (BED) was evaluated in 18 obese women, using standard and eating-specific mindfulness meditation exercises. A single-group extended baseline design assessed all variables at 3 weeks pre-and post-, and at 1, 3, and 6 weeks; briefer assessment occurred weekly.Binges decreased in frequency, from 4.02/week to 1.57/week (p < .001), and in severity. Scores on the Binge Eating Scale (BES) and on the Beck Depression and Anxiety Inventories decreased significantly; sense of control increased. Time using eatingrelated meditations predicted decreases on the BES (r 5 .66, p < .01). Results suggest that meditation training may be an effective component in treating BED.

Physician attitudes toward managing obesity: differences among six specialty groups.

BACKGROUND: The Healthy People 2000 report recommended that physicians more actively address obesity, but little is known about current attitudes and practices of physicians, particularly across specialty areas relevant to obesity as a medical risk factor. METHODS: A mail survey of 1,222 physicians from six specialties (family practice, internal medicine, gynecology, endocrinology, cardiology, and orthopedics) investigated beliefs, attitudes, and practices regarding obesity in relation to medical risk, management, and interest in training and other resources. RESULTS: Specialty groups shared high concern for the health risks of moderate and morbid obesity, but distinct attitudes and patterns of practice emerged. For example, family practitioners, internists, and endocrinologists reported treating obesity themselves in about 50% of obese patients, which correlated with reported use of more active treatment approaches (r = 0.62, P < 0.0001). Other groups reported intervening with 5 to 29% of patients, but expressed greater interest in making referrals. Physicians reporting "any specialty training related to ... obesity" ranged from 4.5% of family practitioners to 36.4% of endocrinologists. CONCLUSIONS: Physicians express high concern with management of obesity but variable interest in assuming this role themselves. Mild obesity may be particularly undertreated. Research is critically needed to assess effective physician roles in weight management and to support the development of physician guidelines.

Tobacco curriculum for medical students, residents and practicing physicians.

Smoking and other tobacco exposure have been recognized for several decades as the most significant preventable factors in premature morbidity and mortality. Most physicians believe they should address the issue of tobacco intake with their patients but are rarely provided with adequate training or support to do so effectively. Recent research identifies several ways in which physicians can have substantial impact on patient smoking rates, by use of very brief patient-centered counseling and by prescribing nicotine replacement therapies. This paper describes a model curriculum for medical students, residents, medical faculty and community physicians that can be integrated into current training and teaching practices. The goal is to create a "preventive" intervention perspective to smoking that is effective, practical, efficacious and cost-effective.

Attitudes toward risk factor behavior of relatives of cancer patients.

BACKGROUND: Targeted health promotion requires an identifiable subpopulation which is accessible, at increased risk, receptive to input, and receptive to change. Relatives of recently diagnosed cancer patients may meet these criteria and have not previously been investigated as recipients of preventive education regarding smoking and diet. METHODS: This study investigates these factors, beliefs regarding perceived susceptibility to cancer, and attitudes toward behavior change in 101 relatives of 50 patients with smoking-related cancers, breast cancer, and other diet-related cancers. Congruence of attitudes between patients and relatives, another possible factor in changing health behaviors, also was assessed. RESULTS: Access to relatives of patients was very high, as was their willingness to discuss these issues (99% of relatives contacted participated in the survey). Relatives' ratings of relevant risk factors were generally higher than those of patients; ratings of their own vulnerability were moderate. Within diagnostic groups, there was high concordance of belief between patients and relatives for certain types of risk, such as heredity for breast cancer (r = 0.81) and smoking for smoking-related cancers (r = 0.52), but not for dietary factors. CONCLUSIONS: The high level of access suggests that relatives may be receptive to discussing issues of behavior risk and change. They are at least as aware as patients of cancer risk factors. Spontaneous behavior change was very low. They may therefore be good candidates for targeted health promotion regarding cancer risk.

Helping hospitalized smokers quit: new directions for treatment and research.

To date, relatively little work has been done to develop or evaluate effective inpatient quit-smoking treatment programs. However, there is growing interest in programs that motivate and assist the hospitalized smoker to quit smoking and remain abstinent. This article presents the rationale for hospital-based smoking treatment programs and introduces a practical minimal-contact treatment model based on extensive studies of primary-care-based and self-help interventions, on a limited number of inpatient studies, and on several prominent theories of health behavior change. Recent controlled and exploratory studies of inpatient interventions are reviewed, including programs for the general medical population and programs for special patient groups such as patients hospitalized for cardiovascular disease, pulmonary disease, cancer, and drug or alcohol dependency. Major findings are summarized, and recommendations are given for future treatment and research.

Smoking intervention for cardiac patients: in search of more effective strategies.

Smoking cessation greatly reduces morbidity and mortality associated with coronary artery disease (CAD). This paper presents details of an individually delivered smoking intervention program for patients with CAD that had been shown to be effective in a previously reported randomized clinical trial. Treatment components include inpatient counseling, followed by a single outpatient visit and follow-up by telephone. This approach compared to traditional outpatient group intervention engenders much higher levels of patient participation and is suitable to the special needs of cardiac patients.

Attitudes of adolescents toward smoking cessation.

We surveyed 375 10th grade students on present behaviors regarding cigarette use and on attitudes concerning smoking cessation. Fourteen percent of students were daily smokers and 7% were occasional smokers. Of the daily smokers, 28% said their most important reason for continued smoking was because they were addicted, and 52% reported two or more prior cessation attempts. When asked the most important reasons for wanting to quit, 70% of occasional smokers and 43% of daily smokers listed health as the most important concern. Only daily smokers (22%) wanted to quit because they thought they were addicted. We conclude that daily smokers among adolescents have many characteristics of adult smokers and that intervention efforts among adolescent smokers may need to be tailored differently for such "adult pattern" smokers as compared to occasional smokers, particularly in regard to addressing the question of smoking as an addictive behavior.

Smoking cessation and severity of disease: the Coronary Artery Smoking Intervention Study.

We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively. Logistic regression analyses, controlling for severity of illness, stage of change, and self-efficacy, among other variables, showed that, at 6 months, the SI had the most effect for patients with more severe coronary artery disease (CAD) who had been admitted with a myocardial infarction (95% confidence interval = 2.05, 124.85). At 12 months, only severity of disease mediated SI effects (95% confidence interval = 3.10, 58.00). Similar results were seen for cotinine-validated cessation. This study confirms the effectiveness of individually administered SI for more seriously ill patients with CAD and raises questions as to how to better intervene with those individuals with less severe disease.

Processes of change in smoking cessation: a cross-validation study in cardiac patients.

The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoking: precontemplation, contemplation, and action. The cardiac sample employed the processes of change more frequently than the nonmedical sample in all stages, but the functional relationship between the stages and processes of change was generally similar for the two groups. The hierarchical structure of the processes of change also was similar for both groups. Differences between the two samples in the use of the processes of change are discussed. These results are the first to support the validity of the stages and processes-of-change model of smoking cessation in a population experiencing severe illness.

Identifying eating patterns in male and female undergraduates using cluster analysis.

Although there is substantial research on eating patterns, little effort has been paid to developing a classification of eating behavior applicable to the general population, rather than to people seeking help for obesity or eating disorders. Using cluster analysis, this study identified six types of eating patterns among normal volunteers. One hundred and sixteen females and 70 males completed a questionnaire concerning weight history, food intake patterns, use of satiation cues, and attitudes toward weight gain. Subjects also completed the Restraint Scale (Herman & Polivy, 1975). Height and weight were measured. Factor analysis reduced the questionnaire to nine internally reliable and meaningful scales; these were then entered into a K-means cluster analysis of subjects. Of the six clusters, two represented mild forms of disordered eating, two could be considered to represent more regulated eating styles, and two were distinguished by differential sensitivity to internal satiation cues. Construct validity of clusters was explored against gender, degree of overweight and scores on the Restraint Scale. Discussion focuses on the values of a cluster analytic technique to identify multidimensional patterns of food intake.

A residents' training program for the development of smoking intervention skills.

This article describes the results of a three-hour training program that teaches residents a patient-centered counseling approach to smoking cessation, emphasizing questioning and exploring feelings, rather than providing information. Fifty internal medicine and family practice residents affiliated with a university medical center were assessed before and after training using questionnaires and videotape documenting changes in their knowledge about smoking, attitudes concerning intervention, and intervention skills. The residents showed a significant increase in knowledge and perceived themselves as having significantly more influence on their patients who smoke after completion of the training program. Counseling skills improved significantly in the use of questions and exploring feelings as judged by blind evaluation of videotapes. The results of this three-hour training program suggest that physicians in training are responsive to the teaching of specialized skills deemed important for promoting health behavior changes in their patients.