A Multi-Modality Intervention Improves Obesity Bias among Medical Students.

Background: Obesity is linked to chronic diseases in adults and children. Its prevalence continues to grow in the United States, necessitating the need for healthcare provider training and presenting an opportunity for the education of future medical providers. Despite this need, effectively implementing obesity education into medical school curricula has been challenging. Anti-obesity bias amongst healthcare providers and trainees represents a significant obstacle to the care of patients with obesity. Obesity bias may affect up to 1/3 of medical students. Methods: This study describes the development and preliminary testing of a brief, 2.5 h multi-modality teaching intervention consisting of online, interactive, and independent learning modules for first-year medical students and a patient panel focused on obesity, obesity bias, and motivational interviewing. The participants took Crandall's anti-fat attitude (AFA) questionnaire before and after an online independent learning module on motivational interviewing and obesity bias. The AFA consists of three subscales ("dislike", "fear of fat", and "willpower"). Individual responses were measured using a nine-point Likert-type response format (0 = very strongly disagree; 9 = very strongly agree). An average composite score was calculated for each subscale. Results: Data were analyzed from 103 first-year medical students enrolled at a college of medicine in the southwestern United States in 2022. The AFA mean composite scores decreased significantly, indicating a decrease in explicit anti-obesity attitude bias after completing the online module. This decrease was present in all three domains of fear (4.63 vs. 3.72, p < 0.001), dislike (1.25 vs. 0.88, p < 0.001) and willpower (3.23 vs. 2.31, p < 0.001). Conclusions: Relatively brief educational interventions can positively impact students' anti-obesity attitudes.

Group Medical Visits for Addressing Weight and Blood Pressure in an Underserved Population.

The effect of group medical visits (GMV) compared to individual medical visits (IMV), on weight and blood pressure in a large primary care practice serving a predominantly underserved population, was assessed. The records of 304 patients attending a weight-loss program were analyzed using mixed-effects regression models. Patients in GMV lost an average of 11.63 lbs, whereas patients in IMV lost an average of 3.99 lbs (p < 0.001). A total of 55% of patients lost ≥7% in GMV compared to 11% of patients in IMV (p ≤ 0.001). Individuals who lost >5% of their baseline weight had a higher reduction in overall blood pressure. For systolic and diastolic blood pressure, the differences between baseline and three months for GMV and IMV were −7.4 vs. 4.1 mm of Hg (p = 0.002) and −4.6 vs. 4.2 mm of Hg (p = 0.003), respectively. Results from this study demonstrate that GMV may be a potentially useful modality for addressing weight and blood pressure in an underserved population.

Gender, psychiatric disability, and dropout from peer support specialist training.

Although research indicates that the prevalence of psychiatric disability differs depending on gender, a paucity of information exists as to whether men and women with psychiatric disability also differ regarding service program outcomes. For a United States Southwest peer support specialist training program, this study examines whether gender moderates the association between psychiatric disability and a key outcome-training dropout. Data were collected for 78 men and 157 women with psychiatric disability and 137 men and 203 women with mental illness only. Logistic regression was used to examine the association between psychiatric disability and dropout, with gender as a moderator variable, and age, education, race/ethnicity, and substance use disorder as control variables. Of trainees with psychiatric disability, dropout was greater among men than women (34.6% and 20.4%, respectively; p < .05). Dropout was also greater among men with psychiatric disability than among men with mental illness only (34.6% and 15.3%; p < .01). In contrast, dropout was similar for women with psychiatric disability and mental illness only (20.4% and 18.7%; p > .05), and dropout was comparable among men and women with mental illness only (15.3% and 18.7%; p > .05). In summary, risk of dropout was substantially higher among men with psychiatric disability than women with psychiatric disability. Gender tailoring of the program's services should be considered to better support training completion. This study's findings also raise questions as to possible underrepresentation of men with psychiatric disability in the peer support workforce training pipeline. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The E.P.I.C. Kids (Encourage, Practice, and Inspire Change) Study.

Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9-12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ±â€¯1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (-0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation.

Artificially sweetened beverages, sugar-sweetened beverages, plain water, and incident diabetes mellitus in postmenopausal women: the prospective Women's Health Initiative observational study.

Background: Sugar-sweetened beverages (SSBs) have been associated with an increased risk of diabetes mellitus (DM), whereas the association with artificially sweetened beverages (ASBs) is unclear.Objective: We aimed to evaluate the associations of ASB and SSB consumption with the risk of developing DM and the potential benefit of replacing SSBs with ASBs or water.Design: The national Women's Health Initiative recruited a large prospective cohort of postmenopausal women between 1993 and 1998. ASB, SSB, and water consumption was measured by lifestyle questionnaires, and DM was self-reported.Results: Of 64,850 women, 4675 developed diabetes over an average of 8.4 y of follow-up. ASBs and SSBs were both associated with an increased risk of DM with an HR of 1.21 (95% CI: 1.08, 1.36) comparing ASB consumption of ≥2 serving/d to never or <3 serving/mo, and an HR of 1.43 (95% CI: 1.17, 1.75) comparing SSB consumption of ≥2 serving/d to <1 serving/wk (1 serving = one 12-ounce can or 355 mL). Subgroup analysis found an increased risk of DM associated with ASBs only in the obese group. Modeling the substitution of SSBs with an equal amount of ASBs did not significantly reduce the risk of developing DM. However, statistically substituting 1 serving of ASBs with water was associated with a significant risk reduction of 5% (HR: 0.95; 95% CI: 0.91, 0.99), whereas substituting 1 serving of SSBs with water was associated with a risk reduction of 10% (HR: 0.90; 95% CI: 0.85, 0.95).Conclusions: ASBs were associated with a 21% increased risk of developing DM, approximately half the magnitude of SSBs (associated with a 43% increased risk). Replacing ASBs and SSBs with water could potentially reduce the risk. However, caution should be taken in interpreting these results as causal because both residual confounding and reverse causation could explain these results.

Relationship Between Marital Transitions, Health Behaviors, and Health Indicators of Postmenopausal Women: Results from the Women's Health Initiative.

BACKGROUND: Historically, marital status has been associated with lower mortality and transitions into marriage were generally accompanied by improved health status. Conversely, divorce has been associated with increased mortality, possibly mediated by changes in health behaviors. METHODS: This study uses data from a prospective cohort of 79,094 postmenopausal women participating in the Women's Health Initiative Observational Study (WHI-OS) to examine the relationship between marital transition and health indicators (blood pressure, waist circumference, body mass index [BMI]) as well as health behaviors (diet pattern, alcohol use, physical activity, and smoking) in a sample of relatively healthy and employed women. Linear and logistic regression modeling were used to test associations, controlling for confounding factors. RESULTS: Women's transitions into marriage/marriage-like relationship after menopause were associated with greater increase in BMI (ß = 0.22; confidence interval (95% CI), 0.11-0.33) and alcohol intake (ß = 0.08; 95% CI, 0.04-0.11) relative to remaining unmarried. Divorce/separation was associated with a reduction in BMI and waist circumference, changes that were accompanied by improvements in diet quality (ß = 0.78, 95% CI, 0.10-1.47) and physical activity (ß = 0.98, 95% CI, 0.12-1.85), relative to women who remained married. CONCLUSION: Contrary to earlier literature, these findings among well-educated, predominantly non-Hispanic white women suggest that marital transitions after menopause are accompanied by modifiable health outcomes/behaviors that are more favorable for women experiencing divorce/separation than those entering a new marriage.

The EPIC Kids Study: a randomized family-focused YMCA-based intervention to prevent type 2 diabetes in at-risk youth.

BACKGROUND: It is well established that behavioral lifestyle interventions resulting in modest weight reduction in adults can prevent or delay type 2 diabetes mellitus; however in children, successful weight management interventions are rarely found outside of controlled clinical settings. The lack of effective community-based programs is a barrier to reducing obesity prevalence and diabetes risk in children. The objective of our study is to develop and test a group-randomized family-centered community-based type 2 diabetes prevention intervention targeting at-risk children, 9- to 12-years-old. METHODS/DESIGN: Using participatory methods, the adult-focused YMCA Diabetes Prevention Program was adapted for families, creating a novel lifestyle behavior change program focused on healthy eating, physical activity, and a supportive home environment. The program will be tested in sixty 9- to 12-year-old children at risk of diabetes and sixty parents over 12 consecutive weeks with two intervention formats randomized by location: a face-to-face instructor-led program, or a hybrid program with alternating face-to-face and mobile technology-delivered content. Anthropometric, behavioral, psychosocial and physiological outcomes will be assessed at baseline, post-intervention (12 weeks), and follow-up (24 weeks). Secondary outcomes are participant acceptability, feasibility, and adherence. The RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) will guide intervention implementation and evaluation. Changes at 12 weeks will be assessed using a paired t-test combining both delivery formats. Exploratory models using linear regression analysis will estimate the magnitude of the difference between the face-to-face and hybrid format. The sample size of 60 children, informed by a previous YMCA intervention in which -4.3 % change in overweight (SE = 1.1) was observed over 6 months, will give us 80 % power to detect an effect size of this magnitude, assuming a one-sided test at alpha = 0.05. DISCUSSION: The proposed study capitalizes on a partnership with the YMCA, a popular and widespread community organization, and uses mobile technologies to extend program reach while potentially reducing burden associated with weekly attendance. The long-term goal is to create a scalable, replicable, and sustainable pediatric "diabesity" prevention program that overcomes existing barriers to the translation of efficacious interventions into effective community programs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02421198 on April 15, 2015.

Families United/Familias Unidas: family group office visits to reduce risk factors for type 2 diabetes.

PURPOSE: The purpose of the Families United/Familias Unidas study was to evaluate the feasibility and efficacy of group office visits on reducing diabetes risk in a multiethnic, primary care population. METHODS: Adults, ages 18 to 70 years, with any diabetes risk factor were recruited to attend 12 group office visits over 6 months. Each participant identified 1 support person, age 14 to 70 years, to accompany them. Data were collected at baseline, postintervention, 6 months, and 12 months. Primary outcome measures were reduction in the total number of predefined, modifiable risk factors (ie, body mass index ≥25 kg/m(2); waist circumference ≥88 cm [women], ≥102 cm [men]; blood pressure ≥140/90 mm Hg; hemoglobin A1C ≥5.7%; fasting insulin ≥15 µU/mL; glycemic index ≥52.5% [women], ≥53.4% [men]; and physical activity <150 min/wk). RESULTS: Thirty-nine participants/supporters completed the intervention (mean age 47.8 ± 12.3 years, 69.2% female, 61.5% white, 35.9% Latino). Risk reduction analysis included only participants/supporters who remained paired at the intervention's end (n = 36). At baseline, primary participants (n = 18) had an average of 4.8 ± 1.6 (standard error) predefined risk factors; supporters (n = 18), 4.1 ± 1.4. Primary participants' risk factors decreased approximately 15% immediately after the 6-month intervention (absolute reduction of 1.1 risk factors) and increased to ~20% reduction 1 year postintervention (absolute reduction of 1.4 risk factors). Risk reduction was primarily due to decreases in dietary glycemic index and fasting insulin levels. CONCLUSIONS: Group visits provide an innovative and potentially efficacious model of diabetes prevention in multiethnic patients with heterogeneous risk factors.

Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

INTRODUCTION: Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians. METHODS: A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared. RESULTS: Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018). DISCUSSION: A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training.

Assessing culturally competent diabetes care with unannounced standardized patients.

BACKGROUND AND OBJECTIVES: More effective diabetes care is desperately needed, especially for ethnic minority populations. Provider cultural competence promises to be an important means for reducing disparities in outcomes for patients with diabetes. The objectives of this study were to understand the role of cultural competence in the diabetes office visit. METHODS: Unannounced standardized patients (SPs) were sent to the offices of 29 family and internal medicine residents and practicing physicians. The SPs portrayed a Mexican American woman newly diagnosed with type 2 diabetes. Using a checklist developed with the input of experts in Hispanic/Latino health care and cultural competence, the SPs evaluated physicians' cultural competence, diabetes care, and general communications skills. RESULTS: The average total SP Checklist score was 70.7-11.0%, with a range of 43.9% to 90.2%. Physicians scored highly on items that measured general communication skills (95.9%) but were less likely to ask about social history (ie, family and community support issues, 51.9% and 48.1%, respectively). Sixty-seven percent of physicians ordered a hemoglobin A1c, 44% referred to ophthalmology, and 15% performed a monofilament exam. Physicians' inquiry into SPs explanatory model of disease (ie, asking about the SPs' views regarding their disease and its treatment) correlated with the performance of several diabetes treatment-related behaviors, Spearman's rho=.466. CONCLUSIONS: The findings provide support for a relationship between inquiry into patients' explanatory models of disease and effective diabetes care. Social history and explanatory model elicitation skills are vital parts of cultural competence training programs and potentially valuable tools for mitigating health disparities.

Intervention in overweight children improves body mass index (BMI) and physical activity.

BACKGROUND: Childhood obesity is a growing epidemic in family medicine with few clinical treatment options. We implemented and evaluated a group office-visit intervention by family physicians for overweight children and their parents, emphasizing nutrition and physical activity within a resiliency psychosocial model. METHODS: The intervention lasted for 3 months, with half of the children crossing over to intervention after 6 months in the study. Participants included 35 children who met eligibility criteria of being in third through fifth grades and having a body mass index (BMI) above the 85th percentile. The 3-month, 12-session intervention, "Choices," included topics on nutrition, physical activity, and resiliency. The sessions were developed for delivery by a family physician and a nutritionist who received training in positive psychology and resilience skills. Main outcome measures were BMI z scores for age and sex and z scores for weight by age and sex, as well as qualitative interviews to understand individual and family processes. RESULTS: The intervention resulted in a significant effect on one primary outcome, BMI z score (-0.138 per 9 months [P = .017]) and a trend toward significance on the weight for age z score (-0.87 per 9 months [P = .09]). The net shift of activity from the low metabolic equivalents (METs) to the high METs had an intervention effect of 2.84 METs (P = .037). Families reported lasting changes in behaviors and attitudes. DISCUSSION: The innovative approach used in this study demonstrated modest efficacy in reducing BMI z score, changing physical activity levels, and possibly shifting family dynamics.

Families United/Familias Unidas: development and implementation of a family-based group office visit model for the primary prevention of type 2 diabetes.

PURPOSE: The purpose of this study is to describe the development and implementation of a new diabetes prevention intervention that combines the benefits of family support with the group office model. Intensive lifestyle modification can effectively delay the onset of type 2 diabetes, yet health providers are challenged in translating these results to their patients. The group outpatient visit model can provide a means to address prevention issues in a financially sustainable manner. METHODS: Materials from the Diabetes Prevention Program and a previously developed group office visit program were combined to create the Families United/Familias Unidas curriculum. The session content utilized a multiculturally tailored approach designed to help participants decrease portion size, decrease carbohydrate intake, increase physical activity, and increase resiliency. Adults aged 18 to 70 were recruited who had any diabetes risk factors but did not have diabetes. Eligible participants enlisted a support person, aged 14 to 70, to join them in the 6-month group office visit intervention. RESULTS: Twenty-nine pairs (n = 58) of primary participants plus support persons were recruited. Participants' average age was 45; 74% were female; 56.9% identified themselves as white and 37.9% as Hispanic/Latino. Over one-third had 4 or more diabetes risk factors. Twelve family group office visits were delivered over 6 months. The attendance rate for those who attended at least one session was 72%. CONCLUSIONS: Group office visits can provide a new sustainable model for diabetes prevention and are a natural fit for primary care physicians in collaboration with other health care professionals, such as dieticians or diabetes educators.

Pilot study of impact of medical-legal partnership services on patients' perceived stress and wellbeing.

UNLABELLED: Medical-legal partnerships (MLPs) bring legal services into health care settings to address patients' unmet legal needs. This pilot project examined whether MLP services impact patients' perceptions of stress and wellbeing. METHODS: Providers referred patients with legal concerns to the Tucson Family Advocacy Program (TFAP), an MLP within a family medicine clinic. Stress levels and wellbeing were assessed before and after legal services using self-administered 10-item Perceived Stress Scale (PSS-10) and Measure Yourself Concerns and Wellbeing (MYCaW) instruments. RESULTS: Sixty-seven participants completed pre- and post-service questionnaires. Within this group, the mean PSS-10 score decreased 8.1 points. Wellbeing scores improved by 1.8 points. Individual changes in perceived stress were strongly related to participants' level of concern regarding the particular legal issues addressed. CONCLUSIONS: Services in patient-centered medical homes to address unmet legal needs have the potential to reduce perceived stress and improve overall wellbeing. Additional studies concerning MLPs and patient outcomes are needed.

Concurrent and longitudinal predictors of self-esteem in elementary and middle school girls.

BACKGROUND: The purpose of this study was to analyze the effects of factors related to self-esteem, both cross-sectionally and longitudinally, among 2 cohorts of girls over a period of 4 years, from elementary through middle school. METHODS: A multiethnic sample of 656 elementary school girls recruited from 13 schools in Hayward, CA, and Tucson, AZ, was evaluated annually over a 4-year period. The McKnight Risk Factor Survey IV was administered, which consists of 103 questions that assess self-esteem, appearance appraisal, effect of body changes, depressed mood, teasing, school performance, and other factors. In addition, participants' heights and weights were measured. RESULTS: The most important predictor of self-esteem in each grade was appearance appraisal, and, in all grades but the eighth, weight-related teasing by either boys or girls was also a predictor of self-esteem. Teasing about weight was more important than body weight itself in predicting self-esteem. Self-esteem was lower in girls who were teased about their weight, even if they believed that it had no effect on how they felt about themselves. School performance predicted self-esteem in grades 6 and 8. In longitudinal analyses, the participant's current perception of her appearance was more important than her previous level of self-esteem in predicting current self-esteem. CONCLUSIONS: The results of this study support the need to allocate funding to address the issue of teasing as 1 of the stressors in the school environment, and to explore further the important relationship between school performance and self-esteem.

Teaching culturally effective diabetes care: results of a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Increased cultural competence is a tool in the fight to eliminate health disparities in people with diabetes. However, questions remain regarding the best cultural competence teaching, evaluation, and dissemination methods. An Internet-based approach requires less facilitator time and provides greater ease of dissemination. We developed and tested a skills-focused, Internet-based course on cultural competence in the context of type 2 diabetes. METHODS: To test the effectiveness of the course, a randomized controlled trial was conducted on a national sample of 122 family medicine residents. The primary outcome was measured by changes in score on the Cultural Competence Assessment Tool (CCAT), a new self-assessment tool developed for this study. RESULTS: Total CCAT score increased significantly after the completion of the Internet course for 58 residents in the experimental group (83.55 before the course, 192.09 after the course) but did not change for the 64 residents in the control group (177.58 at baseline, 177.84 at end of study). On multivariate analysis, the only significant predictor of total CCAT score change was having taken the online course. CONCLUSIONS: A skills-based course on cultural competence, delivered via the Internet, is an effective educational strategy. It has potential for dissemination of standardized content.

KnowPain-50: a tool for assessing physician pain management education.

BACKGROUND: Despite a need for better physician pain management education, there are no widely accepted assessment or outcome measures to support this work. OBJECTIVE: Create a self-assessment tool to measure physician educational needs and the effectiveness of chronic pain educational programs. DESIGN: We used expert consensus to draft a 142-item survey that covered essential areas of chronic pain management. We tested the survey in 106 physicians, including 22 pain management experts and used predefined psychometric criteria to eliminate 70 items. We then eliminated 22 remaining items that did not correlate with the management of a standardized chronic pain patient by 27 academic physicians. We evaluated internal consistency using Cronbach's alpha. RESULTS: The final 50-item survey assessed physician knowledge, attitudes, and beliefs in: 1) initial pain assessment; 2) defining goals and expectations; 3) development of a treatment plan; 4) implementation of a treatment plan; 5) reassessment and management of longitudinal care; and 6) management of environmental issues. The survey demonstrated good internal consistency in all physician populations studied (alpha = 0.77-0.85). Average scores in 84 "pilot" physician users of a CME Website (135.8-138.5) were significantly lower (P < 0.01) than scores in 27 academic physicians (150.0), or 22 pain experts (177.5). CONCLUSIONS: This survey, the KnowPain-50, has good psychometric properties, correlates with clinical behaviors, and appears to distinguish between physicians with different levels of pain management expertise. It may be a useful measure of the effectiveness of physician pain management education programs.

The diverse functions of role models across primary care specialties.

BACKGROUND AND OBJECTIVES: This study investigated the relationship of role models to primary care specialty and gathered information on the attributes and functions of role models. METHODS: A questionnaire on medical school experiences and attitudes was administered to primary care graduates from 24 US medical schools. RESULTS: Questionnaires were completed by 1,457 physicians. Sixty-three percent of primary care respondents had a role model. Having a role model was significantly related to current specialty and ethnicity. Respondents most valued their role models' patient relationships. For family medicine and internal medicine graduates, having a role model was related to more contact and more-positive views of faculty in their specialty. Those with a role model reported that primary care was encouraged at their medical school and were more satisfied with their specialty choice. CONCLUSIONS: Role models may be more important to students who are not well represented among medical school faculty, namely women, underrepresented ethnic minorities, and those interested in family medicine. For family medicine graduates, role models function to moderate negative stereotypes. Role models may also make explicit the values of physicians in that specialty, making students more informed when choosing a specialty and as a consequence more satisfied with the decision.

Family medicine specialty choice and interest in research.

BACKGROUND AND OBJECTIVES: This study investigated interest in research related to declining interest in family medicine by US medical school graduates. METHODS: Twenty-four schools were selected for study based on American Academy of Family Physicians data on the number of their graduates entering family medicine. Data for all graduates in 1997, 1998, and 1999 were obtained from the Association of American Medical Schools matriculation and graduation questionnaires for 23 of 24 schools. RESULTS: Measures of research activity or interest were available on matriculation during medical school and at graduation. All were inversely related to interest in family medicine. Students interested in family medicine were less likely to have selected the field of medicine because of research interests, were less likely to have participated in a research project during medical school, and at graduation were less likely to plan on a career involving research. CONCLUSIONS: Given this pervasive negative relationship between interest in research and interest in family medicine, initiatives intended to increase research within the specialty of family medicine should be evaluated for their effects on student career choices. These initiatives may decrease interest in family medicine among students who don't want to do research but who otherwise might have been interested in family medicine. Conversely, they may increase interest in family medicine among students with research interest, or they may do both.