The association between obesity and self-reported current depression among adult cancer survivors residing in Brazil.

BACKGROUND: The purpose of the current study was to investigate the association between obesity and self-reported current depression (SRCD) in a population-based sample of adult Brazilian cancer survivors. METHODS: The sample for this study (N=930) was based on the 2013 Brazilian National Health Survey. SRCD was assessed using the 8-item Patient Health Questionnaire (PHQ-8). Obesity was defined as a body mass index ≥30 kg/m2. Multivariable weighted logistic regression models were conducted to investigate the association between obesity and SRCD among Brazilian adult cancer survivors. RESULTS: The weighted prevalence of obesity and SRCD among adult cancer survivors was 26.4% (95% confidence interval [CI] 22.5 to 30.3%) and 13.7% (95% CI 10.4 to 17.1%), respectively. Overall there was no significant weighted and adjusted association between obesity and SRCD among cancer survivors (adjusted odds ratio [AOR] 0.99 [95% CI 0.56 to 1.73]). Nevertheless, among cancer survivors of working age (18-59 y), this association was significant (AOR 2.19 [95% CI 1.28 to 3.73]) and therefore obesity is significantly associated with a 119% increase in the odds of SRCD among Brazilian adult cancer survivors of working age. CONCLUSIONS: Since both obesity and depression may lead to worse health and quality of life outcomes in this young and middle-aged population, further investigations are needed in order to establish the causality and directionality of this association.

Radon and lung cancer: What does the public really know?

Radon causes approximately 21,000 deaths annually from lung cancer, making it the second most important cause of lung cancer after smoking. However, the extent of public knowledge about radon is unclear. We systematically reviewed the epidemiologic literature in order to assay the public's understanding about radon and specifically, whether radon is known to cause lung cancer. Radon knowledge has most often been gauged via telephone and in-person responses to the question, "Have you heard about radon?" Our review of 20 such studies reveals that although many individuals have "heard about" radon, many segments of the population, particularly individuals younger than thirty and those with less education, do not know what radon is. Of those who have heard about radon, the majority of respondents in many studies did not know that radon causes lung cancer. Conversely, misinformation about radon is common; approximately 50% of respondents in many studies reported the erroneous belief that radon causes headaches. This suggests that the public has confused the effects of radon with those of carbon monoxide. Rates of radon testing and mitigation are correpondingly low and appear to reflect cognitive defense mechanisms by which individuals believe that their risks from radon are lower than the risks faced by others. Our review suggests that public information materials about radon require revision. Specifically, these should emphasize that radon causes lung cancer and that household carbon monoxide detectors do not detect it. Radon education provided by realtors at the time of residential home sales may be a promising venue to increase radon testing and remediation.

The association between physical activity and depression among individuals residing in Brazil.

PURPOSE: There is very limited literature investigating the association between physical activity (PA) and depression in South American countries such as Brazil. The purpose of the current study was to evaluate the prevalence of depression and its association with PA in a very large, representative sample of young adults (ages 18-39 years) (YA), middle-aged adults (ages 40-59 years) (MAA) and older adults (ages ≥ 60 years) (OA) residing in Brazil. METHODS: The sample for this cross-sectional study was based on the Brazilian National Health Survey conducted in 2013. The Personal Health Questionnaire depression scale (PHQ-8) was applied to measure current (past 2 weeks) depression as the outcome of interest, and the exposure was self-reported PA for leisure. Multivariable weighted logistic regression models were conducted to investigate the association between PA and depression while adjusting for socio-demographic characteristics and number of health comorbidities among YA, MAA and OA. RESULTS: The final study sample size was 59,399 (33,480 females; 25,919 males). After adjusting for the covariates of interest, the lack of PA for leisure was associated with a significant increase in depression only among males (YA: OR 1.45, 95% CI 1.02-2.06; MAA: OR 2.38, 95% CI 1.40-4.03; OA: OR 5.35, 95% CI 2.14-13.37). There was no significant association between PA for leisure and depression among females of all age groups. CONCLUSIONS: Although PA for leisure is not associated with depression among Brazilian females, the obtained results suggest that this association is significant among Brazilian males, who may be able to benefit from PA for leisure to reduce their symptoms of depression.

Changes in Body Mass Index During a 3-Year Elementary School-Based Obesity Prevention Program for American Indian and White Rural Students.

BACKGROUND: Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school-aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children's health. Our study evaluated outcomes of a 3-year elementary school-based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest. METHOD: Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students' third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI). RESULTS: There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students' zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period. CONCLUSION: An elementary school-based health program that addresses a range of students' obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school's primary role in improving community health.

The role of fear and disgust in predicting the effectiveness of television advertisements that graphically depict the health harms of smoking.

INTRODUCTION: Antismoking television advertisements that depict the graphic health harms of smoking are increasingly considered best practices, as exemplified by the Centers for Disease Control and Prevention's current national campaign. Evaluation of responses to these widely used advertisements is important to determine advertisements that are most effective and their mechanisms of action. Our study tested the hypothesis that advertisements rated highest in fear- and disgust-eliciting imagery would be rated as the most effective. METHODS: Our laboratory study included 144 women and men aged 18 to 33; 84% were current nonsmokers. All participants viewed 6 antismoking television advertisements that depicted the health harms of smoking; they rated their responses of fear and disgust and the effectiveness of the advertisements. We used multilevel modeling to test the effects of the following in predicting effectiveness: fear, disgust, the fear-disgust interaction, the advertisement, and the participant's sex and smoking status. Follow-up analyses examined differences in ratings of fear, disgust, and effectiveness. RESULTS: Advertisement, fear, disgust, and the fear-disgust interaction were each significant predictors of effectiveness. Smoking status and sex were not significant predictors. The 3 advertisements that elicited the highest ratings of fear and disgust were rated the most effective. CONCLUSION: Our findings support the hypothesis that antismoking advertisements of health harms that elicit the greatest responses of fear or disgust are the most effective. When advertisements elicit high ratings of both fear and disgust, advertisements with graphic imagery are effective, whereas advertisements without graphic imagery are not.

Telephone-based motivational interviewing to promote physical activity and stage of change progression in older adults.

This study examined the efficacy of motivational interviewing (MI) for increasing physical activity in aging adults. Eighty-six participants aged 55 years and older were randomly assigned to receive either four weekly sessions of telephone-based MI for increasing physical activity, or a healthy activity living guide (information only control). Changes from baseline weekly caloric expenditure from physical activity, self-efficacy for physical activity, and stage of change for physical activity were compared across groups at posttreatment and six months follow-up. Results indicated that MI participants had higher weekly caloric expenditures from physical activity at posttreatment, but not at six months follow-up; higher self-efficacy for physical activity at six months follow-up; and demonstrated greater stage of change progression across assessments. These findings support the use of telephone-based MI for increasing physical activity in older adults in the short-term. Future studies will need to determine if follow-up booster sessions increase long-term efficacy.

Relationships between health behaviors and weight status in American Indian and white rural children.

PURPOSE: Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States. METHODS: Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States. FINDINGS: Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys. CONCLUSIONS: Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

A cognitive-behavioral treatment for depression in rural American Indian middle school students.

Rural American Indian (AI) middle school students with depressive symptoms who participated in a culturally modified version of the Adolescent Coping with Depression (CWD-A) course (n = 8) reported significant improvement in depressive symptoms at post-intervention and at 3-month follow-up. There was also a nonsignificant but clinically relevant decrease in participants' anxiety symptoms. Students reported satisfaction with the intervention, and it was potentially more cost-effective and less stigmatizing than the individualized treatment-as-usual interventions to which it was compared. These results suggest the CWD-A is a promising approach for reducing depressive and anxiety symptoms in rural AI students and should be further evaluated with a larger sample of students.

Community breastfeeding attitudes and beliefs.

The cultural norms of a society have a powerful influence over health behavior decisions such as choosing an infant feeding method. The objective of this study was to explore the community breastfeeding perspective by examining breastfeeding attitudes and beliefs, experiences, and behaviors of a U.S. university community through an online survey. Linear and logistic regressions were used to determine predictors of those who had breastfed and those with positive breastfeeding attitudes and beliefs. Through the findings, the researchers suggest that exposure to breastfeeding and increasing positive breastfeeding attitudes and beliefs are important as the focus for public breastfeeding campaigns.

Carbohydrate antigens in nipple aspirate fluid predict the presence of atypia and cancer in women requiring diagnostic breast biopsy.

BACKGROUND: The goal of this prospective study was to determine (a) concentrations of the carbohydrate biomarkers Thomsen Friedenreich (TF) antigen and its precursor, Tn antigen, in nipple discharge (ND) collected from women requiring biopsy because of a suspicious breast lesion; and (b) if concentration levels predicted pathologic diagnosis. METHODS: Adult women requiring biopsy to exclude breast cancer were enrolled and ND obtained. The samples from 124 women were analyzed using an anti-TF and anti-Tn monoclonal antibodies in direct immunoassay. RESULTS: The highest median concentration in ND for TF and Tn was in women with ductal carcinoma in situ (DCIS). TF was higher in women with 1) cancer (DCIS or invasive) vs. either no cancer (atypia or benign pathology, p = .048), or benign pathology (p = .018); and 2) abnormal (atypia or cancer) versus benign pathology (p = .016); and was more predictive of atypia or cancer in post- compared to premenopausal women. Tn was not predictive of disease. High TF concentration and age were independent predictors of disease, correctly classifying either cancer or abnormal vs. benign pathology 83% of the time in postmenopausal women. CONCLUSIONS: TF concentrations in ND were higher in women with precancer and cancer compared to women with benign disease, and TF was an independent predictor of breast atypia and cancer. TF may prove useful in early breast cancer detection.

Assessing health-related quality of life in Northern Plains American Indians: prominence of physical activity as a health behavior.

Associations of behavioral health risks and healthy behaviors with self-reported health-related quality of life measures were investigated in a Northern Plains American Indian sample. Participants were surveyed in person using the Behavioral Risk Factor Surveillance Survey. The results showed that regular physical activity was significantly associated with better self-reported overall health, fewer mentally unhealthy and activity limitation days in the past 30 days, and with a greater number of good health days.

Assessing health status, behavioral risks, and health disparities in American Indians living on the northern plains of the U.S.

OBJECTIVE: We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities. METHODS: AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews. RESULTS: AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease. CONCLUSIONS: Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

Gender and alcohol consumption: patterns from the multinational GENACIS project.

AIMS: To evaluate multinational patterns of gender- and age-specific alcohol consumption. DESIGN AND PARTICIPANTS: Large general-population surveys of men's and women's drinking behavior (n's > 900) in 35 countries in 1997-2007 used a standardized questionnaire (25 countries) or measures comparable to those in the standardized questionnaire. MEASUREMENTS: Data from men and women in three age groups (18-34, 35-49, 50-65) showed the prevalence of drinkers, former drinkers, and lifetime abstainers; and the prevalence of high-frequency, high-volume, and heavy episodic drinking among current drinkers. Analyses examined gender ratios for prevalence rates and the direction of changes in prevalence rates across age groups. FINDINGS: Drinking per se and high-volume drinking were consistently more prevalent among men than among women, but lifetime abstention from alcohol was consistently more prevalent among women. Among respondents who had ever been drinkers, women in all age groups were consistently more likely to have stopped drinking than men were. Among drinkers, the prevalence of high-frequency drinking was consistently greatest in the oldest age group, particularly among men. Unexpectedly, the prevalence of drinking per se did not decline consistently with increasing age, and declines in high-volume and heavy episodic drinking with increasing age were more typical in Europe and English-speaking countries. CONCLUSIONS: As expected, men still exceed women in drinking and high-volume drinking, although gender ratios vary. Better explanations are needed for why more women than men quit drinking, and why aging does not consistently reduce drinking and heavy drinking outside Europe and English-speaking countries.

Confirmed recall and perceived effectiveness of tobacco countermarketing media in rural youth.

This study was the first to examine rural youth's responses to ten television and radio tobacco countermarketing ads aired during a 13-week field campaign conducted in a U.S. Northern Plains state. A post-campaign survey of 391 girls and boys aged 12-17 years and including 58 American Indian youth provided information about their confirmed recall (CR) of the ads; and for recalled ads, their ratings of the ads' perceived effectiveness (PE). Results were that controlling for age and smoking risk, both American Indian and white girls and boys had the highest CR for the television ad Artery and for the radio ad ABC. Artery shows fatty deposits being squeezed from a deceased smoker's aorta, and ABC presents a former smoker speaking through his electro-larynx. Among the television ads, PE ratings were highest for the ad Artery in both boys and girls. Among the radio ads, boys rated ABC highest, whereas girls rated Joe DoBoer highest-an ad that discusses mouth lesions that developed from using smokeless tobacco. An analysis of race/ethnicity differences in PE for the ad Artery and ABC indicated American Indian and white youth considered these ads equally effective. These findings indicate certain TV and radio ads depicting graphic health harms from tobacco-especially the TV ad Artery and the radio ad ABC-are highly recalled and perceived as effective by both American Indian and white girls and boys from a rural region. Future research is needed to better understand which individual- and media-level factors increase the likelihood that anti-tobacco ads will be effective in reducing youth tobacco use.

The role of free-play physical activity in healthy blood glucose maintenance in children with type 1 diabetes mellitus.

Medical management for children with type 1 diabetes mellitus, including insulin administration to control high blood glucose levels (BGL), is crucial. However, a child-controlled behavioural strategy, like physical activity, to maintain target BGL may be warranted. To demonstrate, pre- and post-activity BGL were collected for 73 children aged 8- to 14-years attending a diabetes camp. Change in BGL across one session of a free-play swimming activity was analysed. Average BGL was significantly reduced from 197.18 mg/dl to 177.78 mg/dl across one 45 min session, and male gender predicted larger reductions. With safety precautions and within the context of appropriate medical management, free-play activity could be used as a strategy for maintaining target BGL.

Attitudes, knowledge, and intentions related to breastfeeding among university undergraduate women and men.

The purpose of the current study was to examine university undergraduate women's and men's attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population.

Alcohol use and suicidal behavior in women: longitudinal patterns in a U.S. national sample.

BACKGROUND: Much of the research on suicidality has focused on adolescents and completed suicides, with less attention to types of suicidal behavior (ideation and attempts) that are more common among women. Research has associated women's suicidality with hazardous drinking, adverse childhood experiences, relationship problems, depression, and earlier suicidal behavior. The longitudinal analyses here examine long-term antecedents of suicidal ideation among women in the U.S. general population. METHODS: We used 1981 and 1991 survey data to predict post-1991 suicidal ideation in a 1996 national sample of 709 women aged 26 to 54 (538 current drinkers). Predictors included 1991 measures of hazardous drinking, depressive episodes, illicit drug use, general health, children at home, interaction with partner, and previous suicidal ideation. Predictors from childhood included recalled parental drinking, parental love or rejection, early drinking and sexual intercourse, and sexual abuse. Demographic predictors included age, education, and ethnicity. A three-stage structural equation model that included these variables was evaluated with Mplus for women who were drinkers in 1991 and/or 1996. RESULTS: Almost all women who attempted suicide also reported suicidal ideation. Among women drinkers, suicidal ideation before 1991 was more common in the following groups: Latinas, women who believed that their parents had rejected them, and women who reported childhood sexual abuse. Hazardous drinking and poorer health in 1991, childhood histories of sexual abuse and early drinking, and previous suicidal ideation predicted suicidal ideation after 1991. Domestic stressors in 1991 (inability to share feelings with a partner and having four or more young children at home) also predicted subsequent suicidal ideation, but depressive episodes did not. Suicidal ideation was less likely among women drinkers who reported past illicit drug use. CONCLUSIONS: Suicidal ideation among women drinkers was largely predictable from previous suicidal ideation, hazardous drinking, adverse childhood experiences, and domestic stressors. Higher rates of pre-1991 suicidal ideation among Latinas indicate a need for further study of ethnic influences on suicidality. Reduced suicidal ideation among women with past illicit drug use suggests that conclusions about such use from shorter-term studies may be oversimplified. Understanding women's suicidal ideation, as a precursor to suicidal actions, requires more detailed research on pathways by which hazardous drinking as well as combined distress from childhood experiences and adult domestic environments may increase women's despair and thoughts of suicide.

The effects of alcohol and anxiousness on physiological and subjective responses to a social stressor in women.

Several studies have examined the validity of the tension reduction hypothesis as an explanatory model for the development of alcohol problems, but support has been inconsistent. In recent years, researchers have begun to examine how various individual differences variables moderate the relationship between alcohol consumption and reduction of anxiety. The present study examined how 40 women, either moderate or low in anxiety sensitivity (AS), responded to a social stressor (giving a body image speech) after consuming either a low dose of alcohol (0.4 ml/kg of body weight) or a placebo. Results indicated that of the participants reporting moderate AS, participants consuming alcohol reported more stress dampening as measured by heart rate in anticipation to the stressor than participants not consuming alcohol. Furthermore, of the participants consuming alcohol, those reporting high social anxiety reported more of an increase in heart rate than participants not consuming alcohol. Findings are discussed in terms of considering individual differences factors when examining predictions made from the tension reduction hypothesis.

Self-reports of forgetting and remembering childhood sexual abuse in a nationally representative sample of US women.

OBJECTIVE: The purpose of this article is to describe patterns of forgetting and remembering childhood sexual abuse (CSA) in a nationally representative sample of US adult women. METHOD: The respondents were a national probability sample of 711 women, aged 26 years to 54 years, residing in noninstitutional settings in the contiguous 48 states. In a 1996 face-to-face interview survey, trained female interviewers asked each respondent whether she had experienced any sexual coercion by family members or nonfamily members while growing up; whether she believed that she had been sexually abused (by family members or others); and whether she had ever forgotten the CSA experiences and, if so, how she had subsequently remembered them. RESULTS: Twenty-one and six-tenths percent of respondents reported having sexually coercive experiences while growing up; of these, 69.0% indicated that they felt they had been sexually abused. More than one-fourth of respondents who felt sexually abused reported that they had forgotten the abuse for some period of time but later remembered it on their own. Only 1.8% of women self-described as sexually abused reported remembering the abuse with the help of a therapist or other professional person. CONCLUSIONS: The findings indicate that, among women who report CSA, forgetting and subsequently remembering abuse experiences is not uncommon. According to the women surveyed, however, very few (1.8%) of those who felt abused recovered memories of CSA with help from therapists or other professionals. As one of the few studies of CSA memories in a nationally representative sample, this study suggests that therapist-assisted recall is not a major source of CSA memories among women in the US general population.