An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the 'Stand & Move at Work' group randomized trial

BACKGROUND

American workers spend 70-80% of their time at work being sedentary. Traditional approaches to increase moderate-vigorous physical activity (MVPA) may be perceived to be harmful to productivity. Approaches that target reductions in sedentary behavior and/or increases in standing or light-intensity physical activity [LPA] may not interfere with productivity and may be more feasible to achieve through small changes accumulated throughout the workday METHODS/DESIGN: This group randomized trial (i.e., cluster randomized trial) will test the relative efficacy of two sedentary behavior focused interventions in 24 worksites across two states (N=720 workers). The MOVE+ intervention is a multilevel individual, social, environmental, and organizational intervention targeting increases in light-intensity physical activity in the workplace. The STAND+ intervention is the MOVE+ intervention with the addition of the installation and use of sit-stand workstations to reduce sedentary behavior and enhance light-intensity physical activity opportunities. Our primary outcome will be objectively-measured changes in sedentary behavior and light-intensity physical activity over 12months, with additional process measures at 3months and longer-term sustainability outcomes at 24months. Our secondary outcomes will be a clustered cardiometabolic risk score (comprised of fasting glucose, insulin, triglycerides, HDL-cholesterol, and blood pressure), workplace productivity, and job satisfaction DISCUSSION: This study will determine the efficacy of a multi-level workplace intervention (including the use of a sit-stand workstation) to reduce sedentary behavior and increase LPA and concomitant impact on cardiometabolic health, workplace productivity, and satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02566317 (date of registration: 10/1/2015).

Exposure to Sources of Heart Disease Prevention Information: Community Type and Social Group Differences

Community pluralism predicted both exposure to sources of heart disease prevention information and diversity of source exposure in three Upper Midwest cities (small, medium, large) over a ten-year period. Community differences in both outcomes narrowed, however. The study suggested that during the 1980s, the sheer amount of information about the topic of heart disease prevention and the proliferation of electronic media reduced typical community system and SES-based differences in exposure.

Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis

Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), and Pf (β=-0.23; P=0.001) were significant independent predictors of LV mass. Conversely, TAC (β=-0.43; P<0.001), SVR (β=0.22; P<0.001), and Pf (β=-0.18; P=0.004) were independently associated with the LV wall/LV cavity volume ratio. Women demonstrated greater pulsatile load than men, as evidenced by a lower indexed TAC (0.89 versus 1.04 mL/mm Hg per square meter; P<0.0001), whereas men demonstrated a higher indexed SVR (34.0 versus 32.8 Wood Units×m2; P<0.0001). In conclusion, various components of arterial load differentially associate with LV hypertrophy and concentric remodeling. Women demonstrated greater pulsatile load than men. For both LV mass and the LV wall/LV cavity volume ratio, the loading sequence (ie, early load versus late load) is an important determinant of LV response to arterial load.

Reflection magnitude as a predictor of mortality: the Multi-Ethnic Study of Atherosclerosis

Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian population. It is unknown whether this association is present in a multiethnic population or whether it is independent of subclinical atherosclerosis. We hypothesized that reflection magnitude (defined as the ratio of the amplitude of the backward wave [Pb] to that of the forward wave [Pf]) is associated with all-cause mortality in a large multiethnic adult community-based sample. We studied 5984 participants enrolled in the Multi-Ethnic Study of Atherosclerosis who had analyzable arterial tonometry waveforms. During 9.8±1.7 years of follow-up, 617 deaths occurred, of which 134 (22%) were adjudicated cardiovascular deaths. In Cox proportional hazards models, each 10% increase in reflection magnitude was associated with a 31% increased risk for all-cause mortality (hazard ratio [HR]=1.31; 95% confidence interval [CI]=1.11-1.55; P=0.001). This relationship persisted after adjustment for various confounders and for markers of subclinical atherosclerosis (HR=1.23; 95% CI=1.01-1.51; P=0.04), including the coronary calcium score, ankle-brachial index, common carotid intima-media thickness, and ascending thoracic aortic Agatston score. Pb was independently associated with all-cause mortality in a similarly adjusted model (HR per 10 mm Hg increase in P(b)=2.18; 95% CI=1.21-3.92; P=0.009). Reflection magnitude (HR=1.71; 95% CI=1.06-2.77; P=0.03) and P(b) (HR=5.02; 95% CI=1.29-19.42; P=0.02) were mainly associated with cardiovascular mortality. In conclusion, reflection magnitude is independently associated with all-cause mortality in a multiethnic population initially free of clinically evident cardiovascular disease. This relationship persists after adjustment for a comprehensive set of markers of subclinical atherosclerosis.

Structural and interpersonal characteristics of family meals: associations with adolescent body mass index and dietary patterns

The last decade of research has suggested that family meals play an important role in promoting healthful dietary intake in youth. However, little is known about the structural characteristics and interpersonal dynamics of family meals that might help to inform why family meals are protective for youth. The current mixed methods, cross-sectional study conducted in 2010-2011 includes adolescents and parents who participated in two linked population-based studies. Participants included 40 parents (91.5% female) and adolescents (57.5% female) from the Minneapolis/St Paul, MN, area participating in EAT (Eating and Activity Among Teens) 2010 and F-EAT (Families and Eating and Activity Among Teens). The structural (eg, length of the meal, types of foods served) and interpersonal characteristics (eg, communication, emotion/affect management) of family meals were described, and associations between interpersonal dynamics at family meals and adolescent body mass index and dietary intake were examined via direct observational methods. Families were videorecorded during two mealtimes in their homes. Results indicated that family meals were approximately 20 minutes in length, included multiple family members, were typically served family style (70%), and occurred in the kitchen 62% of the time and 38% of the time in another room (eg, family room, office). In addition, significant associations were found between positive interpersonal dynamics (ie, communication, affect management, interpersonal involvement, overall family functioning) at family meals and lower adolescent body mass index and higher vegetable intake. These findings add to the growing body of literature on family meals by providing a better understanding of what is happening at family meals in order to inform obesity-prevention studies and recommendations for providers working with families of youth.

Video game-based exercise, Latino children's physical health, and academic achievement

BACKGROUND

There is a paucity of research investigating the effects of innovative physical activity programs on physical health and academic performance in the Latino population.

PURPOSE

To examine the impact of Dance Dance Revolution [DDR]-based exercise on Latino children's physical fitness and academic achievement.

DESIGN

A repeated-measures crossover design was used. In Year 1, Grade-4 students were assigned to the intervention group and offered 30 minutes of exercise (DDR, aerobic dance) three times per week. Grade-3 and Grade-5 students made up the comparison group and were offered no structured exercise at school. In Year 2, the Grade-4 students were again assigned to the intervention, whereas Grade-5 and Grade-6 students were in the comparison group.

SETTING/PARTICIPANTS

Assessments were conducted with 208 Latino school children.

MAIN OUTCOME MEASURES

The baseline measures included time to complete a 1-mile run, BMI, and reading and math scores. Data were collected again 9 months later. Overall, data were collected in 2009-2011 and analyzed in 2012.

RESULTS

Data yielded significant differences between the intervention and comparison groups in differences in 1-mile run and math scores in Year 1 and Year 2. The results also revealed net differences in the intervention versus comparison group scores on the 1-mile run for Grade 3 (p<0.01). Additionally, children's yearly pre-test and post-test BMI group changes differed (χ(2)((2)) = 6.6, p<0.05) only for the first year of intervention.

CONCLUSIONS

The DDR-based exercise intervention improved children's cardiorespiratory endurance and math scores over time. Professionals should consider integrating exergaming at schools to achieve the goals of promoting a physically active lifestyle and enhancing academic success among Latino children.

Food responsiveness, parental food control and anthropometric outcomes among young American Indian children: cross-sectional and prospective findings

OBJECTIVE

Assess cross-sectional and prospective associations between food responsiveness and parental food control and anthropometric outcomes among American Indian children.

DESIGN

Parents/caregivers completed psychosocial surveys and trained staff measured children's anthropometry at baseline (kindergarten) and at follow-up (1st grade) as part of a school-based obesity prevention trial (Bright Start).

SETTING

On/near the Pine Ridge Indian reservation.

PARTICIPANTS

422 child (51% female, mean age=5.8 years, 30% overweight/obese) and parent/caregiver (89% mothers) dyads.

MAIN OUTCOME MEASURES

Two independent variables (child's Food Responsiveness and Parental Control scales) and six child anthropometric dependent variables (overweight status, body mass index z-score, % body fat, waist circumference, triceps skinfold, subscapular skinfold). Linear regression analyses, stratified by sex and adjusted for age and treatment condition.

RESULTS

Baseline Food Responsiveness scale scores were positively associated with all six baseline anthropometric outcomes among boys (P's all <.01), but not girls. Parental Control scale scores were not significantly associated with outcomes and no prospective associations were statistically significant.

CONCLUSIONS

Responsiveness to food may be associated with excess adiposity in young American Indian boys, however, the effects are not detectable over time. Obesity prevention programs for American Indian children may benefit by addressing eating without hunger among boys.

Unhealthy weight-control behaviours, dieting and weight status: a cross-cultural comparison between North American and Spanish adolescents

The aim of the current study was to examine and compare dieting and unhealthy weight-control behaviours (UWCB) in population-based samples in two large urban areas in Spain (Barcelona) and in the USA (Twin Cities of Minneapolis and St. Paul, Minnesota). Additionally, use of UWCB across weight categories was explored in both samples. Participants included 1501 adolescents from Barcelona (48% girls, 52% boys) and 2793 adolescents from the Twin Cities (53% girls, 47% boys). The main outcome measures were dieting, UWCB (less extreme and extreme) and weight status. Although dieting and UWCB were prevalent in both samples, particularly among girls, the prevalence was higher in the US sample. In both countries, the report of dieting and use of UWCB was highest among overweight and obese youth. Prevention interventions that address the broad spectrum of eating and weight-related problems should be warranted in light of the high prevalence and co-occurrence of overweight and unhealthy weight-related behaviours.

A phylogenetic analysis of the genus Pleurothallis, with emphasis on Pleurothallis subsection Macrophyllae-Fasciculatae, using nuclear ITS and chloroplast DNA sequencing

Several revisions of the genus Pleurothallis have been proposed. Luer has proposed that Pleurothallis species in subgenus Scopula be segregated into the genera Colombiana and Ancipitia. Szlachetko and Margonska (2001) proposed the genus Zosterophyllanthos for Pleurothallis subsection Macrophyllae-Fasciculatae. As an alternative, Luer (2005) proposed the genus Acronia by uniting Pleurothallis subsection Macrophyllae-Fasciculatae with subsections Acroniae and Amphygiae. The molecular phylogenetic studies by Pridgeon and Chase (2001), however, suggested that these taxonomic revisions might not be justified. We report here a more detailed phylogenetic analysis of the genus Pleurothallis, with emphasis on subsection Macrophyllae-Fasciculatae, with data primarily from nuclear ITS sequencing, supplemented with preliminary data from plastid DNA (rpoB2, rpoC1, and ycf1) sequencing. Some initial, tentative conclusions can be drawn. In the strict consensus maximum-parsimony tree of ITS data, many of the clades collapse, leaving a polytomy with a single, highly supported node that tentatively could be used to delimit the genus Pleurothallis. Such a tree would argue for an expanded concept of the genus Pleurothallis, in which the groups Ancipitia, Colombiana, and Acronia/Zosterophyllanthos, if shown to be monophyletic, are relegated to subgenera. 

Predictors of adolescent breakfast consumption: longitudinal findings from Project EAT

OBJECTIVE

To identify predictors of breakfast consumption among adolescents.

METHODS

Five-year longitudinal study Project EAT (Eating Among Teens). Baseline surveys were completed in Minneapolis-St. Paul schools and by mail at follow-up by youth (n = 800) transitioning from middle to high school. Linear regression models examined associations between baseline predictors and follow-up breakfast consumption.

RESULTS

Frequency of breakfast consumption at follow-up was positively associated with baseline breakfast consumption and inversely associated with baseline weight concerns (P < .01). Perceptions of being too rushed in the morning to eat a healthful breakfast were associated with lower breakfast frequency 5 years later among girls (P < .01). After adjusting for baseline breakfast consumption, none of the associations with predictor variables remained statistically significant.

CONCLUSIONS AND IMPLICATIONS

Early adolescence is an important time to establish regular breakfast consumption. Interventions aimed at increasing breakfast consumption should include messages about healthful weight management and ideas for quick, healthful breakfasts.

Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial

BACKGROUND

Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain.

METHODS

To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers motivates male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control, a cluster randomized trial (BARBER-1) of HTN control was conducted among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Participants underwent 10-week baseline BP screening, and then study sites were randomized to a comparison group that received standard BP pamphlets (8 shops, 77 hypertensive patrons per shop) or an intervention group in which barbers continually offered BP checks with haircuts and promoted physician follow-up with sex-specific peer-based health messaging (9 shops, 75 hypertensive patrons per shop). After 10 months, follow-up data were obtained. The primary outcome measure was change in HTN control rate for each barbershop.

RESULTS

The HTN control rate increased more in intervention barbershops than in comparison barbershops (absolute group difference, 8.8% [95% confidence interval (CI), 0.8%-16.9%]) (P = .04); the intervention effect persisted after adjustment for covariates (P = .03). A marginal intervention effect was found for systolic BP change (absolute group difference, -2.5 mm Hg [95% CI, -5.3 to 0.3 mm Hg]) (P = .08).

CONCLUSIONS

The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician follow-up. Further research is warranted.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00325533.

Obesity as a prospective predictor of depression in adolescent females

OBJECTIVE

Both obesity and depression are prominent during adolescence, and it is possible that obesity is a trigger for adolescent depression. The purpose of this paper is to evaluate whether overweight or obese status contributes to the development of depression in adolescent girls.

DESIGN

Participants were 496 adolescent girls who completed interview based measures of depression and had their height and weight measured at four yearly assessments. Repeated measures logistic regressions with generalized estimating equations were used to evaluate whether overweight or obese status were associated with major depression or an increase in depressive symptoms the following year.

MAIN OUTCOME MEASURES

Major depression and depressive symptoms were evaluating using a modified version of the K-SADS interview. Overweight and obese status was determined by using standardized protocols to measure height and weight.

RESULTS

RESULTS showed that obese status, not overweight status, was associated with future depressive symptoms, but not major depression. This study demonstrated that obesity is a risk factor for depressive symptoms, but not for clinical depression.

CONCLUSIONS

As depressive symptoms are considered along the spectrum of depression with clinical depression at the high end, these results suggest that weight status could be considered a factor along the pathway of development of depression in some adolescent females.

Parental report versus child perception of familial support: which is more associated with child physical activity and television use?

BACKGROUND

Parent-report and child perception of familial support for weight-related behaviors may not be congruent. This research explores whether parent-report or child perception is more strongly associated with child-reported physical activity and television (TV) use.

METHODS

Elementary school children (n = 73) participating in Ready. Set. ACTION!, a theater-based obesity prevention pilot program in Saint Paul, MN, and their parents completed surveys assessing familial support for physical activity and limitations on TV use in fall 2006. Paired t tests examined congruency between parent-report and child perception. Linear regression models adjusted for sociodemographics explored the associations between familial support and child-reported behavior.

RESULTS

Levels of agreement between parent-report and child perception for support for physical activity and limitations on TV use were approximately 70%. Compared with parent-report for physical activity support, child perception was more strongly associated with child physical activity (beta = .17, P = .02). Neither parent-report nor child perception for support for limitations on TV use was associated with child TV use.

DISCUSSION

Although parent-report and child perception of familial support for physical activity and to limit TV use were similar, child perception was more strongly associated with child physical activity behavior. More research, probably qualitative, is needed to examine how parents and children define and perceive parental support.

Population strategies to enhance physical activity: the Minnesota Heart Health Program

A population-wide, community-based program in cardiovascular disease prevention, the Minnesota Heart Health Program (MHHP), has been designed to promote more frequent and vigorous physical activity in North American communities, along with improved eating and smoking patterns. The physical activity component of this broad-based education strategy is based on the facilitation which physical activity provides to lowering of other risk characteristics for heart disease and its enhancement of other healthy behaviors and on the potential for prevention of elevated risk in the first place. The rationale for a population strategy to complement medical approaches to prevention is that exercise patterns are largely socially learned and culturally determined. The MHHP Physical Activity Program is implemented through three major education strategies: direct education, community organization, and mass communications. Early results from this 10-year project indicate that it is feasible to enter U.S. communities and to involve their leadership actively in MHHP activities of health promotion. Moreover, attitudes, knowledge, awareness, participation, and behaviors related to exercise and eating patterns appear to be changed by the program. Nevertheless, there are problems in the design, implementation, analysis and interpretation of population changes in physical activity and other health behaviors in community demonstration programs. These issues, along with their solutions, should provide useful information for medical science and for the public health about population strategies of disease prevention and health promotion.

Major patterns of dietary intake in adolescents and their stability over time

A diet-patterns approach has often been used to describe eating patterns in adults but has rarely been used in adolescents. We used principal components factor analysis to: 1) describe the dietary patterns of a cohort of ethnically diverse youth during early and middle adolescence; 2) examine if the patterns persisted 5 y later; and 3) study secular trends. Project EAT-I (Time 1) collected data on 4746 middle school (younger cohort) and high school (older cohort) students in 31 Minnesota schools in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n = 2516) of the original cohort in 2003-2004. Dietary intake was assessed at Time 1 and 2 using the Youth/Adolescent FFQ. We identified dietary patterns separately by cohort (older/younger) and gender (boys/girls). At Time 1, we identified 4 patterns in early and middle adolescents that were relatively consistent between boys and girls that we labeled vegetable, fruit, sweet/salty snack food, and starchy food. Longitudinal analyses indicated that patterns were relatively stable over 5 y, with the exception of a new fast food pattern. Examination of age-matched secular trends in middle adolescents (older cohort at Time 1, younger cohort at Time 2) showed similar patterns, with the exception of the fast food pattern that emerged at Time 2 among middle adolescent boys. We identified dietary patterns in this adolescent population that differed from those usually found in adults. Patterns were similar across gender and age cohorts and were relatively similar over time, with the exception a new fast food pattern.

Characteristics and dietary patterns of adolescents who value eating locally grown, organic, nongenetically engineered, and nonprocessed food

OBJECTIVE

To examine characteristics of adolescents who value eating locally grown, organic, nongenetically engineered, and/or nonprocessed food and whether they are more likely than their peers to meet Healthy People 2010 dietary objectives.

DESIGN

Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT: Eating Among Teens).

SETTING

Participants completed a mailed survey and food frequency questionnaire in 2004.

PARTICIPANTS

Males and females (N = 2516), ages 15-23 years.

MAIN OUTCOME MEASURES

Dietary intake of fruit, vegetables, fat, grains, calcium, and fast food.

ANALYSIS

Chi-square tests, logistic regression models adjusting for race/ethnicity, socioeconomic status, and vegetarian status.

RESULTS

Percentages of adolescents who reported that it was somewhat or very important that their food be locally grown, organic, nongenetically engineered, and nonprocessed were 20.9%, 23.2%, 34.1%, and 29.8%, respectively. Those who valued each practice were more likely than their peers to be nonwhite (P < .001) and have a low socioeconomic status (P < .001). Adolescents who valued >/= 2 practices were more likely than their peers to have a dietary pattern consistent with the Healthy People 2010 objectives (P < .001) for fruit, vegetable, and fat intake.

CONCLUSIONS AND IMPLICATIONS

It may beneficial to discuss alternative food production practices as part of nutrition education programs for adolescents.

Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications

OBJECTIVE

To compare the prevalence of disordered eating and body dissatisfaction between adolescents with type 1 diabetes and a population-based sample of youth.

SUBJECTS

A clinic-based sample of 143 adolescents (73 male and 70 female) with type 1 diabetes who participated in the Assessing Health and Eating among Adolescents with Diabetes (AHEAD) study was compared with a population-based sample of 4746 youths (2377 male, 2357 female, and 12 missing) who participated in Project Eating Among Teens (Project EAT).

METHOD

Participants completed surveys and anthropometric measurements of height and weight.

RESULTS

Although some adolescents with type 1 diabetes endorsed unhealthy weight control practices, overall, they reported less weight dissatisfaction and were less likely to use any unhealthy weight control behaviors and more likely to report regular meal consumption than the population-based sample. Females with type 1 diabetes were less likely to report dieting, fasting, or eating very little food to control weight during the past year than their population-based peers. However, males with type 1 diabetes were less likely than their peers to exercise and to consume more fruits and vegetables for healthy weight control. Of medical concern were insulin omission (1.4% males and 10.3% females) and dosage reduction (1.4% males and 7.4% females) as means of weight control among youth with type 1 diabetes.

CONCLUSIONS

Despite medical supervision, some adolescents with type 1 diabetes reported unhealthy weight control behaviors and weight concerns, including insulin manipulation. Altering the insulin regimen may cause complications. All adolescents warrant attention for unhealthy behaviors and weight concerns.

Child versus parent report of parental influences on children's weight-related attitudes and behaviors

OBJECTIVE

To compare parent and child report of parental weight-related behaviors and examine their respective associations with child's weight-related outcomes.

METHODS

Seventy-three parent-child dyads completed self-administered surveys that assessed parent and child report of parental direct weight-related behaviors (comments to child about weight, encourage child to diet) and indirect behaviors (dieting, comments about own weight/appearance). Outcome variables included child's body dissatisfaction, weight concerns, and dieting.

RESULTS

Considerable disagreement (21-30%) was found between parent and child report of parental weight-related behaviors. Both the parent and child report of direct parental behaviors were associated with child's outcomes. Child report of parental indirect behaviors was more consistently associated with child's outcomes than parent report.

CONCLUSION

Parent weight-related behaviors, both direct and indirect, are positively associated with child's weight-related attitudes and behaviors.

Alcohol and malt liquor availability and promotion and homicide in inner cities

We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.

Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT

Objective

To examine longitudinal associations of parental report of household food availability and parent intakes of fruits, vegetables and dairy foods with adolescent intakes of the same foods. This study expands upon the limited research of longitudinal studies examining the role of parents and household food availability in adolescent dietary intakes.

Design

Longitudinal study. Project EAT-II followed an ethnically and socio-economically diverse sample of adolescents from 1999 (time 1) to 2004 (time 2). In addition to the Project EAT survey, adolescents completed the Youth Adolescent Food-Frequency Questionnaire in both time periods, and parents of adolescents completed a telephone survey at time 1. General linear modelling was used to examine the relationship between parent intake and home availability and adolescent intake, adjusting for time 1 adolescent intakes. Associations were examined separately for the high school and young adult cohorts and separately for males and females in combined cohorts.

Subjects/setting

The sample included 509 pairs of parents/guardians and adolescents.

Results

Vegetables served at dinner significantly predicted adolescent intakes of vegetables for males (P = 0.037), females (P = 0.009), high school (P = 0.033) and young adults (P = 0.05) at 5-year follow-up. Among young adults, serving milk at dinner predicted dairy intake (P = 0.002). Time 1 parental intakes significantly predicted intakes of young adults for fruit (P = 0.044), vegetables (P = 0.041) and dairy foods (P = 0.008). Parental intake predicted intake of dairy for females (P = 0.02).

Conclusions

The findings suggest the importance of providing parents of adolescents with knowledge and skills to enhance the home food environment and improve their own eating behaviours.

Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9-11 year old girls: outcomes of the Cal-Girls study

Background

A two-year, community-based, group-randomized trial to promote bone mass gains among 9–11 year-old girls through increased intake of calcium-rich foods and weight-bearing physical activity was evaluated.

Methods

Following baseline data collection, 30 5th-grade Girl Scout troops were randomized to a two-year behavioral intervention program or to a no-treatment control group. Evaluations were conducted at baseline, one year, and two years. Measures included bone mineral content, density, and area (measured by DXA), dietary calcium intake (24-hour recall), and weight-bearing physical activity (physical activity checklist interview). Mixed-model regression was used to evaluate treatment-related changes in bone mineral content (g) for the total body, lumbar spine (L1-L4), proximal femur, one-third distal radius, and femoral neck. Changes in eating and physical activity behavioral outcomes were examined.

Results

Although the intervention was implemented with high fidelity, no significant intervention effects were observed for total bone mineral content or any specific bone sites. Significant intervention effects were observed for increases in dietary calcium. No significant intervention effects were observed for increases in weight-bearing physical activity.

Conclusion

Future research needs to identify the optimal dosage of weight-bearing physical activity and calcium-rich dietary behavior change required to maximize bone mass gains in pre-adolescent and adolescent girls.

Factors associated with errors in self-reports of stature, weight, and body mass index in Minnesota adolescents

PURPOSE

Obtaining stature, weight, and body mass index (BMI) from self-reports rather than by direct measurements is highly attractive economically and logistically, but there are few data available for adolescents that allow evaluation of potential sources of reporting bias. Because self-reports are based on self perceptions, personal characteristics of youth may be related to errors in reporting.

METHODS

Differences between self-reported and measured stature, weight, and BMI were investigated for a sample of 3797 Minnesota youth, 12 to 18 years of age. Gender, age, race/ethnicity, socioeconomic status (SES), and measured body size were examined as potential factors associated with errors in self-reports.

RESULTS

Self-reported stature, weight, and BMI were generally highly correlated with corresponding measured dimensions, although adolescents of both genders systematically overestimated their statures, underestimated their weights, and underestimated BMI. Significant associations of errors in self-reports with age, race/ethnicity, and socioeconomic status suggested that differences in self perceptions or value ascribed to body size varies according to these personal characteristics. Systematic errors in self-reported stature, weight, and BMI were negatively associated with the corresponding measured dimension when adjusted for age, race/ethnicity and SES, such that prevalences of overweight based on BMI from self-reported measures were systematically underestimated relative to measured values.

CONCLUSIONS

Self-reports of stature, weight, and BMI are on the average, valid representations of their measured counterparts; nevertheless, errors in the self-reports are systematically related to characteristics of youth. Consequently, findings from these studies should be interpreted carefully.

Predicting energy expenditure from accelerometry counts in adolescent girls

PURPOSE

Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has not been conducted in middle school girls. We concurrently assessed energy expenditure and accelerometer counts during physical activities on adolescent girls to develop an equation to predict energy expenditure.

METHODS

Seventy-four girls aged 13-14 yr performed 10 activities while wearing an Actigraph accelerometer and a portable metabolic measurement unit (Cosmed K4b2). The activities were resting, watching television, playing a computer game, sweeping, walking 2.5 and 3.5 mph, performing step aerobics, shooting a basketball, climbing stairs, and running 5 mph. Height and weight were also assessed. Mixed-model regression was used to develop an equation to predict energy expenditure (EE) (kJ.min(-1)) from accelerometer counts.

RESULTS

Age (mean [SD] = 14 yr [0.34]) and body-weight-adjusted correlations of accelerometer counts with EE (kJ.min(-1)) for individual activities ranged from -0.14 to 0.59. Higher intensity activities with vertical motion were best correlated. A regression model that explained 85% of the variance of EE was developed: [EE (kJ.min(-1)) = 7.6628 + 0.1462 [(Actigraph counts per minute - 3000)/100] + 0.2371 (body weight in kilograms) - 0.00216 [(Actigraph counts per minute - 3000)/100](2) + 0.004077 [((Actigraph counts per minute - 3000)/100) x (body weight in kilograms)]. The MCCC = 0.85, with a standard error of estimate = 5.61 kJ.min(-1).

CONCLUSIONS

We developed a prediction equation for kilojoules per minute of energy expenditure from Actigraph accelerometer counts. This equation may be most useful for predicting energy expenditure in groups of adolescent girls over a period of time that will include activities of broad-ranging intensity, and may be useful to intervention researchers interested in objective measures of physical activity.

An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS Study

OBJECTIVES

We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias.

METHODS

Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions.

RESULTS

A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs -2.8% control, P =.002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P =.04) were observed. There were no significant changes in student self-reported food choices.

CONCLUSIONS

School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.

Does socioeconomic position moderate the effects of race on cardiovascular disease mortality?

OBJECTIVE

Cardiovascular disease (CVD) rates differ markedly by minority status, with younger Blacks having some of the highest CVD mortality rates in the United States. A major objective of this study was to assess whether socioeconomic position moderates the effects of race or minority status on CVD mortality.

DESIGN

The sample included 443 Black and 21,182 White men, and 415 Black and 24,929 White women, 45 years and older, who died of CVD from 1992-1998, and who had lived in the Twin Cities 5-county area. Using individual and neighborhood level measures of socioeconomic position, we hypothesized that socioeconomic position would moderate the effects of race on CVD mortality. Test hypotheses were analyzed using Poisson regression analysis.

RESULTS

Socioeconomic position moderated the effects of race on CVD mortality among older men, but not in older women. Older Black men who lived in more impoverished neighborhoods had significantly and disproportionately higher CVD mortality rates than did older White men living in more impoverished neighborhoods; this was not the case among older Black and White men living in less impoverished neighborhoods. Race was independently related to CVD mortality among younger men and women, with younger Black men and women having significantly higher CVD mortality rates than younger White men and women. The Black-White rate for Black women was twice that of White women.

CONCLUSION

Socioeconomic position as measured by neighborhood poverty can moderate the effects of race on CVD mortality in older Black and White men. This may not have been as apparent had socioeconomic position not been treated as a major variable of interest, and measured at multiple levels.

A randomized trial of education to prevent lead burden in children at high risk for lead exposure: efficacy as measured by blood lead monitoring

In this article we report on the effectiveness of a community-based, culture-specific, controlled trial of intensive peer education aimed at preventing lead burden in children 0-36 months of age within a neighborhood with high risk for lead exposure. Mothers (n = 594) were randomly assigned to control or intervention groups. Offspring blood lead levels were assessed every 4 months. All participants received brochures on basic lead prevention strategies. Intervention participants were offered 20 bi-weekly educational sessions by same-ethnicity peer educators over the course of 1 year, and quarterly booster sessions for 2 years afterward. The intervention group's educational curriculum included information on lead sources (e.g., paint, dust, water, soil, and risks from home repairs and remodeling), health consequences of lead burden, and strategies to reduce lead exposure, including household cleaning, hygiene, safe use of water, and nutritional recommendations. Results indicated that of the 378 children contributing sufficient blood data for analysis, 23% had blood lead levels > 10 micro g/dL before 3 years of age. Intervention participants were more likely to maintain blood lead levels < 10 micro g/dL than were controls (81% vs. 73%; p = 0.08). Multivariate analyses demonstrated that the intervention reduced the risk of blood lead levels > 10 micro g/dL by approximately 34%. We conclude that although intensive education resulted in a lower proportion of children with elevated lead levels, education alone cannot be relied upon to prevent lead burden.

The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines

BACKGROUND

This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes.

METHODS

Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors.

RESULTS

Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions.

CONCLUSIONS

The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Area characteristics, individual-level socioeconomic indicators, and smoking in young adults: the coronary artery disease risk development in young adults study

The 10-year follow-up examination in 1995-1996 to the population-based Coronary Artery Disease Risk Development in Young Adults Study was used to compare the strength with which socioeconomic indicators at the individual and area levels are related to smoking prevalence and to investigate contextual effects of area characteristics. When categories based on similar percentile cutoffs were compared, differences across area categories in the odds of smoking were smaller than differences across categories based on individual-level indicators. In Whites, there was evidence of a significant contextual effect of area characteristics on smoking: Living in the most disadvantaged area quartiles was associated with 50-110% higher odds of smoking, even after controlling for individual-level socioeconomic indicators. Clear contextual effects of area characteristics were not present in Blacks, but there was evidence that contextual effects may emerge at higher levels of individual-level socioeconomic position. Similar results were obtained for census tracts and block groups. Even in the presence of contextual effects, area measures may underestimate associations of individual-level variables with health outcomes. On the other hand, as illustrated by the presence of contextual effects, area- and individual-level measures are likely to tap into different constructs.

Lipid standardization of serum fat-soluble antioxidant concentrations: the YALTA study

BACKGROUND

Blood lipids can influence fat-soluble antioxidant concentrations and confound their interpretation as indicators of antioxidant intake status and disease risk.

OBJECTIVES

The objectives were to identify lipoproteins that can confound the interpretation of serum fat-soluble antioxidants, to evaluate the amount of the confounding, and to recommend a method for standardizing blood concentrations of fat-soluble antioxidants.

DESIGN

Several methods of lipid standardization of fat-soluble antioxidants were evaluated in a large cohort of young adults with the use of both cross-sectional and longitudinal data analysis.

RESULTS

Tocopherol and carotenoid concentrations were associated with plasma total cholesterol and its components, LDL, HDL, and VLDL cholesterol (estimated as plasma total triacylglycerols/5), some of which were independent predictors for all of the fat-soluble antioxidants. Among supplement nonusers, the most amphipathic (polar) of the antioxidants (alpha-tocopherol, gamma-tocopherol, and zeaxanthin plus lutein) and lycopene were associated strongly with these lipid fractions (R(2) = 0.09, 0.40). Consistent with a causal association in which blood antioxidant concentrations change as blood lipid concentrations change, similar relations were found for changes in blood antioxidant and lipid concentrations over a 7-y period. Concentrations of the remaining carotenoids (beta-cryptoxanthin, alpha-carotene, and beta-carotene) had a weaker association with plasma lipoproteins (R(2) < 0.06). Similar relations were found for supplement users.

CONCLUSIONS

The simultaneous adjustment of the concentrations of tocopherols, zeaxanthin plus lutein, and lycopene for VLDL, HDL, and LDL cholesterol is recommended. This method is practical and can provide a basis for the standardization of carotenoid and tocopherol concentrations.

Dating violence among a nationally representative sample of adolescent girls and boys: associations with behavioral and mental health

OBJECTIVE

To determine the prevalence of adolescent dating violence, associations between dating violence and behavioral and mental health, and the percentage of youth who remain in potentially harmful relationships due to a fear of being hurt if they leave.

METHODS

A nationally representative population-based sample of 3533 youth in 9th through 12th grades completed the Commonwealth Fund Survey of the Health of Adolescent Boys and Girls.

RESULTS

Overall, 17% of girls and 9% of boys reported adolescent dating violence. Adolescents from lower socioeconomic backgrounds were more likely to report dating violence than youth from higher backgrounds. Dating violence was associated with dieting, binge and purge behaviors, cigarette smoking, alcohol consumption, drug use, suicidal thoughts, depression, and poorer self-esteem for both genders. Approximately 50% of girls and boys reporting both physical and sexual dating violence reported staying in relationships out of fear of physical harm.

CONCLUSIONS

Adolescent dating violence is prevalent among both girls and boys and is associated with detriments to behavioral and mental health. Youth in potentially harmful relationships may remain due to fear of being physically hurt if they leave. Clinical implications addressing both girls and boys are discussed.

A pricing strategy to promote sales of lower fat foods in high school cafeterias: acceptability and sensitivity analysis

Prices of four low fat foods were reduced about 25% and prices of three high fat foods were increased about 10% to determine the impact on food purchases in a Midwestern suburban high school cafeteria to explore the impact of price on purchases. Low fat foods averaged about 13% of total sales. Sensitivity analysis was used to estimate that low fat foods would probably have averaged about 9% of total sales without the reduced price.

Declining beta-cell function in type 2 diabetes: 5-year follow-up and immunologic studies of the population of Wadena, MN

The aim of the study was to describe 5-year changes in meal-stimulated pancreatic insulin reserve in adults with normal and impaired glucose tolerance (NGT, IGT) and diabetes, with or without islet-related antibodies. This was a 5-year follow-up of 270 residents of Wadena, MN, of northern European origin, with good kidney function, defined as creatinine clearance greater than 60 mL/min/1.73 m(2). The subjects comprised a population-based sample originally studied in 1986 to 1987. Urine C-peptide (CP), in a 260-minute collection, was the integrated measure of insulin secretion; Ensure-Plus (Ross, Columbus, OH) was the liquid meal. Islet cytoplasmic antibodies (ICA), insulin autoantibodies (IAA), and glutamate decarboxylase antibodies (GAD65ab) were measured. In 182 subjects with NGT, there was no mean within-subject change in urine CP over 5 years (P =.34). In 41 subjects with impaired GT (IGT), there was a moderate, but nonsignificant, increase in mean CP, and 6 (15%) subjects increased. In 37 type 2 diabetic subjects not taking insulin (type 2-No Ins), who had a mean diabetes duration at the 5-year examination of 9.6 +/- 6.3 years, there was a 21% decrease in mean urine CP (P =.012), attributable mostly to a major drop in 8 of the 37 subjects (22%). Islet-related antibody tests were mostly negative; GAD65ab positivity was related to CP decline only among insulin-taking subjects. In summary, in Wadena adults, meal-stimulated urine CP was stable or increased over 5 years in subjects with NGT and IGT, but CP decreased significantly in about one fifth of type 2-No Ins subjects, with no relation to antibody test results.

Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables

OBJECTIVE

To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 4746 adolescent students.

DESIGN

A survey was administered to students in classrooms at 31 secondary schools in a large metropolitan area in Minnesota, United States. Height and body weight were measured.

SUBJECTS

Students in grades 7-12 who were enrolled in participating schools, had parental consent and were in attendance on the day of data collection.

MEASUREMENTS

Frequency of fast food restaurant use (FFFRU), dietary intake, and demographic and behavioral measures were self-reported. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Height and body weight were directly measured.

RESULTS

FFFRU was positively associated with intake of total energy, percent energy from fat, daily servings of soft drinks, cheeseburgers, french fries and pizza, and was inversely associated with daily servings of fruit, vegetables and milk. FFFRU was positively associated with student employment, television viewing, home availability of unhealthy foods, and perceived barriers to healthy eating, and was inversely associated with students' own and perceived maternal and peer concerns about healthy eating. FFFRU was not associated with overweight status.

CONCLUSIONS

FFFRU is associated with higher energy and fat intake among adolescents. Interventions to reduce reliance on fast food restaurants may need to address perceived importance of healthy eating as well as time and convenience barriers.

Adolescent binge/purge and weight loss behaviors: associations with developmental assets

PURPOSE

To study associations between binge/purge and weight loss behaviors and "developmental assets" among adolescent girls and boys.

METHODS

The Search Institute's Profile of Student Life: Attitudes and Behaviors self-report questionnaire was administered to 48,264 girls and 47,131 boys in grades 6 through 12 at schools in 213 cities or towns across the United States. The 156-item questionnaire measured 40 "developmental assets," or protective factors associated with successful adolescent development. Developmental assets were examined using multiple logistic regression among students who reported binge/purge behaviors, weight loss behavior, both, or neither.

RESULTS

Developmental assets related to positive identity were the strongest discriminators of binge/purge and weight loss behaviors in both girls and boys. Girls who reported binge/purge and weight loss behaviors were about half as likely to report feeling a sense of purpose [odds ratio (OR) = 0.45, 95% confidence interval (CI) = 0.40, 0.50] and high self-esteem (OR = 0.55, 95% CI = 0.49, 0.61), compared with girls not reporting either of these behaviors. Among boys the ORs were: sense of purpose OR = 0.53 (95% CI = 0.46, 0.61) and self-esteem OR = 0.76 (95% CI = 0.65, 0.88). Assets related to values about abstinence from alcohol, drugs, or sex ("restraint") were also significant correlates. Girls and boys who reported these values were less likely to report binge/purge and weight loss behaviors, compared with those who did not report these values (girls: OR = 0.56, 95% CI = 0.50, 0.63; boys: OR = 0.83, 95% CI = 0.70, 0.97).

CONCLUSIONS

Internal assets such as self-esteem, sense of purpose, and values related to abstinence from alcohol and sex appear to be protective against unhealthy eating behaviors and may reflect a general resilience that buffers against a broad range of health risk behaviors.

Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program

PURPOSE

To evaluate results of screening for syphilis, gonorrhea, and chlamydia among youth in a federally funded job training program.

METHODS

Data were evaluated from medical records of 12,881 randomly selected students in 54 U.S. job training centers during 1996. The intake medical evaluation includes serologic testing for syphilis. The policy was for females to receive a pelvic examination with gonorrhea and chlamydia testing and for males to be first screened with a urine leukocyte esterase (LE) assay, with follow-up gonorrhea and chlamydia testing for those with positive LE results.

RESULTS

Adjusting for our sampling strategy, among females, an estimated 9.2% had a positive chlamydia test, 2.7% a positive gonorrhea test, and 0.4% had a positive syphilis test. Gonorrhea and chlamydia rates among females were highest in African-American followed by Native American students. Chlamydia infection was most common in younger women < or = 17 years of age. An estimated 0.1% of males had a positive syphilis test, and 4.8% of males a positive urine LE test. Of 103 LE-positive males tested for gonorrhea and chlamydia, only 27 (26%) had a positive test for one of these STDs.

CONCLUSIONS

Our study supports routine screening of adolescents for gonorrhea and chlamydia, including those youth from socioeconomically disadvantaged backgrounds. Because individuals from such backgrounds may not regularly interact with traditional clinical health care systems, screening and treatment should be offered in alternative settings, such as the job training program described in this study.

Pricing and promotion effects on low-fat vending snack purchases: the CHIPS Study

OBJECTIVES

This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines.

METHODS

Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites. Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention.

RESULTS

Price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales. Average profits per machine were not affected by the vending interventions.

CONCLUSIONS

Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations.

Occupational attainment, smoking, alcohol intake, and marijuana use: ethnic-gender differences in the CARDIA study

OBJECTIVES

To evaluate the prospective interrelationship of smoking, alcohol intake, marijuana use, and educational and occupational attainment of Black and White young adults.

METHODS

Logistic or mixed model linear regression were used to evaluate relationships between self-reported substance use, ethnicity, gender, college graduation, and four measures of occupational attainment.

RESULTS

College graduation in the next 10 years was negatively associated with smoking and marijuana use, but not daily alcohol consumption in all ethnic and gender groups. In Whites, marijuana use was associated with less prestigious occupations and lower family income, while smoking was unrelated and moderate daily drinking was positively associated. In Blacks, marijuana use was generally unrelated to occupational measures, while smoking and daily alcohol consumption were negatively associated.

CONCLUSIONS

Relationships between smoking, marijuana use, daily drinking, and occupational attainment were not universally negative in this age group. Substance use, particularly smoking, is associated with reduced occupational attainment in Blacks compared with Whites after considering sociodemographic factors potentially limiting educational progression and occupational attainment.

Tuberculin skin testing among economically disadvantaged youth in a federally funded job training program

Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age (p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered.

Autologous versus unrelated donor allogeneic marrow transplantation for acute lymphoblastic leukemia

Bone marrow transplantation (BMT) can cure patients with high-risk or recurrent acute lymphoblastic leukemia (ALL). Those lacking a related donor can receive either autologous or histocompatible unrelated donor (URD) marrow. Autotransplantation may result in higher risk of relapse, whereas URD allografts, although associated with serious posttransplant toxicities, may reduce relapse risk. Six years (1987 to 1993) of consecutive autologous BMT (University of Minnesota, Dana Farber Cancer Institute; n = 214) were compared with URD transplants (National Marrow Donor Program; n = 337). Most transplants (70% autologous, 48% URD) were in early remission (first or second complete remission [CR1 or CR2]); 376 patients (75% autologous, 64% URD) were less than 18 years old. Autologous BMT led to significantly lower transplant-related mortality (TRM; relative risk [RR] 0.35; P = .001). URD transplantation offered greater protection against relapse (autologous RR 3.1; P = .001). Patients greater than 18 years old, women, and BMT recipients beyond CR2 had higher TRM, whereas adults, BMT recipients in CR2+, or BMT recipients during 1991 through 1993 had significantly more relapse. After 25 months median follow-up, 100 URD and 56 autologous recipients survive leukemia free. URD BMT in CR2 resulted in superior disease-free survival (DFS), especially for adult patients. Multivariate analysis showed superior DFS for children, men, and BMT during CR1 or 2. Autologous and URD BMT can extend survival for a minority of patients unlikely to be cured by chemotherapy, and the results with either technique are comparable. Greater toxicity and TRM after URD BMT are counterbalanced by better protection against relapse. Prospective studies addressing additional clinical variables are needed to guide clinical decision making about transplant choices for patients with ALL.

Cytokine-primed bone marrow stem cells vs. peripheral blood stem cells for autologous transplantation: a randomized comparison of GM-CSF vs. G-CSF

Autologous transplantation for non-Hodgkins lymphoma and Hodgkin's disease is widely used as standard therapy for those with high-risk or relapsed tumor. Peripheral blood stem cell (PBSC) collections have nearly completely replaced bone marrow stem cell (BMSC) harvests because of the perceived advantages of more rapid engraftment, less tumor contamination in the inoculum, and better survival after therapy. The advantage of PBSC, however, may derive from the hematopoietic stimulating cytokines used for PBSC mobilization. Therefore, we tested a randomized comparison of GM-CSF vs. G-CSF used to prime either BMSC or PBSC before collection for use in autologous transplantation. Sixty-two patients receiving transplants (31 PBSC; 31 BMSC) for non-Hodgkin's lymphoma (n = 51) or Hodgkin's disease (n = 11) were treated. All patients received 6 days of randomly assigned cytokine. Those with cellular marrow in morphologic remission underwent BMSC harvest, while those with hypocellular marrow or microscopic marrow tumor involvement had PBSC collected. Neutrophil recovery was similarly rapid in all groups (median 14 days; range 10-23 days), though two patients had delayed neutrophil recovery using GM-CSF primed PBSC (p = 0.01). Red cell and platelet recovery were significantly quicker after BMSC mobilized with GM-CSF or PBSC mobilized with G-CSF. This speedier hematologic recovery resulted in earlier hospital discharge as well. However, in multivariate analysis, neither the stem cell source nor randomly assigned G-CSF vs. GM-CSF was independently associated with earlier multilineage hematologic recovery or shorter hospital stay. Relapse-free survival was not independently affected by either the assigned stem cell source or the randomly assigned priming cytokine, though malignant relapse was more frequent in those assigned to PBSC (RR of relapse 3.15, p = 0.03). These data document that BMSC, when collected following cytokine priming, can yield a similarly rapid hematologic recovery and short hospital stay compared with cytokine-primed PBSC. Using primed BMSC, no difference in malignant relapse or relapse-free survival was observed. These findings suggest that despite widespread use of PBSC for transplantation, BMSC, when collected following hematopoietically stimulating cytokines, may remain a satisfactory source of stem cells for autologous transplantation. G-CSF and GM-CSF are both effective in priming autologous PBSC or BMSC for collection.

Alcohol-related problems among black, Hispanic and white men: the contribution of neighborhood poverty

OBJECTIVE

We examined the cross-sectional relationships between race/ethnicity, neighborhood poverty and alcohol-related problems among black, Hispanic and white male drinkers. Test hypotheses were that black and Hispanic men living in more impoverished neighborhoods would report increased numbers of alcohol-related problems than comparable white men.

METHOD

Study hypotheses were tested in a sample of 744 black, Hispanic and white men participating in the 1992 National Alcohol Follow-up Survey. Study hypotheses were analyzed using generalized linear model regression analysis.

RESULTS

Neighborhood poverty had a greater effect on alcohol-related problems in black than in white men, partially supporting our hypothesis. Black men living in more impoverished neighborhoods reported greater numbers of alcohol-related problems than comparable white men; there were no race differences among more affluent men. Neighborhood poverty had little effect on alcohol-related problems in Hispanic men.

CONCLUSIONS

Findings suggest that, giving unfavorable economic conditions, black men will report greater numbers of alcohol-related problems than comparable white men.

Predictors of increases in alcohol-related problems among black and white adults: results from the 1984 and 1992 National Alcohol Surveys

We examined increases in self-reported alcohol-related problems among black and white adult drinkers using data from the 1984 and 1992 National Alcohol Surveys. The objectives of the study were to determine whether alcohol consumption, drinking norm, or socioeconomic status were related to increases in alcohol-related problems. Two types of self-reported alcohol-related problems were analyzed using regression methods: drinking consequences and alcohol dependence symptoms. Results indicated that increases in alcohol consumption were associated with increased drinking consequences for white men, but increased consumption had little affect for black men. Changes in drinking norms regarding non-social drinking were associated with increased in drinking consequences among black men, such norms showed little affect on drinking consequences for white men. Despite substantial increases in alcohol consumption among black women from 1984 to 1992, there were no significant racial/ethnic differences in drinking consequences or alcohol dependence symptoms among women. Changes in socioeconomic status were however related to increases in drinking consequences and alcohol dependence symptoms in women, but not in men. Findings suggest that liberal drinking norms may have greater long term consequences for black than white men. Socioeconomic status, on the other hand, may have greater explanatory power in predicting increases in alcohol-related problems in women than in men.

A pricing strategy to promote low-fat snack choices through vending machines

OBJECTIVES

This study examined the role of price on purchases of low-fat snacks from vending machines.

METHODS

Sales of low-fat and regular snacks were monitored in nine vending machines during a 4-week baseline, a 3-week intervention in which prices of low-fat snacks were reduced 50%, and 3 weeks postintervention.

RESULTS

The proportion of low-fat snacks purchased was 25.7%, 45.8%, and 22.8% in the three periods, respectively. Total snack purchases did not vary by period.

CONCLUSIONS

Reducing relative prices may be effective in promoting lower-fat food choices in the population. Vending machines may be a feasible method for implementing such nutrition interventions.