A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial.

INTRODUCTION: Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS: The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS: Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS: A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.

The Effects of Caloric Education, Trial-by-Trial Feedback, and their Interaction on College-Aged Women's Abilities to Estimate Caloric Content.

Background: Many people track the caloric content of food, given its relevance to weight loss, gain, or maintenance. A better understanding of the psychological underpinnings of caloric-content estimation for unhealthy foods is of significant psychological and public-health interest. Purpose: This study investigated whether college-aged women could be trained to estimate the caloric content of unhealthy foods more accurately via exposure to caloric-content education, trial-by-trial feedback, and their combination. Methods: The caloric content of 84 foods was estimated and three transfer tasks were completed by 238 undergraduate women. Mixed-effects modeling estimated three aspects of the quadratic function linking true and judged caloric content: threshold (average perceived caloric content), linear sensitivity, and change in sensitivity as caloric content increases. Results: On average, college-aged women underestimated caloric content, demonstrated substantial linear sensitivity to caloric content, and did not show reduced sensitivity as caloric content increased. Trial-by-trial feedback, but not Caloric Education, enhanced caloric estimation on the first two tasks. Conclusions: College-aged women show biased but sensitive judgments of the caloric content of unhealthy food presented in images. Initial evidence suggests that trial-by-trial feedback may be an efficacious strategy to enhance caloric-content estimation, at least when viewing static images of foods.

Perceptions of food healthiness among free-living women.

BACKGROUND: Improving our understanding of food-related healthiness perception may be beneficial to assist those with eating- and weight-related problems. PURPOSE: This study replicates and extends prior work by examining normative and person-specific predictors of the perceived healthiness of foods in a sample of free-living women. METHODS: One hundred sixty-nine women from the community judged the healthiness of 104 foods that varied in fat, fiber, sugar, and protein content. Mixed-effects modeling estimated normative influences of food-specific and individual-specific characteristics on each participant's utilization of the nutrients when judging healthiness. RESULTS: When judging healthiness, free-living women relied substantially on fat and fiber independently of other nutrients. In contrast, reliance on fat and fiber was moderated by the presence of protein and sugar. Three bivariate interactions emerged between: 1) fiber and sugar; 2) fat and protein; and 3) fiber and protein. Binge-eating symptoms and frequency of healthy food consumption positively correlated with independent reliance on fat as a predictor of perceived healthiness. CONCLUSIONS: Public health campaigns should continue to encourage free-living women to consume adequate amounts of protein. Additionally, free-living women should be reminded that the presence of sugar in foods without nourishing components (i.e., fiber, protein) is problematic, and consuming these foods in excess should be avoided. Healthy food consumption appears to enhance perceptions of food healthiness.

Internet-based preventive intervention for reducing eating disorder risk: A randomized controlled trial comparing guided with unguided self-help.

Student Bodies, an internet-based intervention, has successfully reduced weight/shape concerns and prevented eating disorders in a subset of college-age women at highest risk for an eating disorder. Student Bodies includes an online, guided discussion group; however, the clinical utility of this component is unclear. This study investigated whether the guided discussion group improves program efficacy in reducing weight/shape concerns in women at high risk for an eating disorder. Exploratory analyses examined whether baseline variables predicted who benefitted most. Women with high weight/shape concerns (N = 151) were randomized to Student Bodies with a guided discussion group (n = 74) or no discussion group (n = 77). Regression analyses showed weight/shape concerns were reduced significantly more among guided discussion group than no discussion group participants (p = 0.002; d = 0.52); guided discussion group participants had 67% lower odds of having high-risk weight/shape concerns post-intervention (p = 0.02). There were no differences in binge eating at post-intervention between the two groups, and no moderators emerged as significant. Results suggest the guided discussion group improves the efficacy of Student Bodies in reducing weight/shape concerns in college students at high risk for an eating disorder.

Disordered eating links to body-relevant and body-irrelevant influences on self-evaluation.

We investigated eating- and weight-related correlates of self-evaluation influences (SEIs) and examined the extent to which such SEIs can be both over- and undervalued and the extent to which measurement strategy affects SEIs. A female undergraduate sample (n = 549) completed 3 measures of SEI importance and questionnaires assessing disordered eating (DE), body mass index (BMI), and depression. SEI measures included Likert scale, rank ordering, and pairwise forced choice; a subset (n = 62) also completed the Shape- and Weight-Based Self-Esteem Scale (SAWBS). Only rank ordering, forced choice, and SAWBS constrain choices among SEIs, such that prioritizing one SEI necessarily deprioritizes another, which reflects real-world restrictions on individuals' allotment of time and energy (e.g., spending hours exercising daily necessarily reduces time available for other activities). By any measure, women with DE overvalue body shape and weight. The constraining measures reveal systematic undervaluation of intelligence and achievement among women with DE and an enhanced effect of DE on the overvaluation of weight and on the undervaluation of being a good person among those with higher BMI. Depressed women's self-evaluations overemphasize appearance and underemphasize interpersonal relationships. Self-evaluations of women with DE are marked by both over- and undervaluation of relevant SEIs; the overvaluation of shape and weight in DE may be associated with costs. Future use of constraining measures, such as forced choice or rank ordering, may enhance our understanding of both over- and underemphasized SEIs among women with DE.

The association of food characteristics and individual differences with ratings of craving and liking.

Craving and liking are related to eating-related problems, but less is known about the association of specific food characteristics (e.g., sugar, fat) with craving/liking. The relation of individual differences in eating behavior with these craving and liking patterns is also relatively unknown. We examine the nomothetic impact of sugar, fat and processing on food craving and liking and the moderation of these effects by idiographic factors (e.g., Body Mass Index [BMI], hunger). One hundred and five overweight and obese women completed craving and liking ratings on 180 foods that differed in levels of sugar, fat and processing. Food craving was linked positively to fat content, but negatively to sugar. Food liking was associated negatively with sugar content and processing level. Addictive-like eating predicted elevated overall food craving and liking, and increased craving and liking for processed foods. Attempted restriction efforts were unrelated to craving and liking. BMI was associated with less craving for fattier foods and lower liking for the average food. Hunger was associated with increased craving for the average food. These findings highlight the role of fat in cravings and differences in craving and liking based on BMI, loss of control over eating, and hunger. These findings are relevant to theories of problematic eating and the development of eating-related interventions.

An indirect approach to the measurement of nutrient-specific perceptions of food healthiness.

BACKGROUND: Enhancing our understanding of food-related perceptions is critical to assist those with eating- and weight-related problems. PURPOSE: This study investigated normative and person-specific aspects of perceived food healthiness in terms of nutritional characteristics and the relevance of nutritional knowledge to perceived healthiness. METHODS: Two hundred sixty-three undergraduate women judged the healthiness of 104 foods and completed nutrient knowledge tasks. Multilevel modeling estimated average and person-specific reliance on and knowledge about nutrients. RESULTS: Participants relied substantially on fat and fiber, moderately on sugar, and minimally on protein. Disordered eating symptoms moderately predicted greater reliance on fat. Nutritional knowledge was highest for sugar and lowest for fiber. Nutritional knowledge and utilization were unrelated. CONCLUSIONS: Public health campaigns should educate college-aged women further on the health consequences of sugar and protein consumption. Explicit knowledge of nutrients may not be prioritized when judging food healthiness.