Relationships between depression, gender, and unhealthy weight loss practices among overweight or obese college students.

INTRODUCTION: Unhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students. METHODS: Students (body mass index between 25.0 and 34.9 kg/m(2)) from three Southern California universities (M(age) = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form. RESULTS: Twenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e(B) = 1.14 [confidence interval, CI: 1.08-1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e(B) = 1.04 [CI: 0.93-1.16]). CONCLUSION: Among an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.

Design and implementation of a randomized controlled social and mobile weight loss trial for young adults (project SMART).

PURPOSE: To describe the theoretical rationale, intervention design, and clinical trial of a two-year weight control intervention for young adults deployed via social and mobile media. METHODS: A total of 404 overweight or obese college students from three Southern California universities (M(age) = 22( ± 4) years; M(BMI) = 29( ± 2.8); 70% female) were randomized to participate in the intervention or to receive an informational web-based weight loss program. The intervention is based on behavioral theory and integrates intervention elements across multiple touch points, including Facebook, text messaging, smartphone applications, blogs, and e-mail. Participants are encouraged to seek social support among their friends, self-monitor their weight weekly, post their health behaviors on Facebook, and e-mail their weight loss questions/concerns to a health coach. The intervention is adaptive because new theory-driven and iteratively tailored intervention elements are developed and released over the course of the two-year intervention in response to patterns of use and user feedback. Measures of body mass index, waist circumference, diet, physical activity, sedentary behavior, weight management practices, smoking, alcohol, sleep, body image, self-esteem, and depression occur at 6, 12, 18, and 24 months. Currently, all participants have been recruited, and all are in the final year of the trial. CONCLUSION: Theory-driven, evidence-based strategies for physical activity, sedentary behavior, and dietary intake can be embedded in an intervention using social and mobile technologies to promote healthy weight-related behaviors in young adults.

Validating stage of change measures for physical activity and dietary behaviors for overweight women.

OBJECTIVE: To investigate the construct, concurrent and predictive validity of stage of change measures for physical activity (PA), and intakes of fruit and vegetables (FVs), dietary fiber (FB) and dietary fat (DF) among a sample of overweight women. DESIGN: Subjects were 401 women (mean age=41, s.d.=8.7 years; mean body mass index=32.35, s.d.=4.6) recruited to participate in a 12-month weight loss intervention trial. Concurrent validity tests included (1) self-report of current behavior, (2) decisional balance (for example, pros and cons of behavior change), (3) self-efficacy, (4) the MTI Actigraph accelerometer (for the PA staging measure), and (5) a food-frequency questionnaire (for all dietary staging measures). Predictive validity was assessed through tests of the relationship between the baseline stage of change measures and their corresponding behavior 1-year later. RESULTS: Coefficient alpha-tests of internal consistency exceeded 0.70 on the majority of scales. Concurrent validity tests indicated strong validity evidence for three staging measures and little validity for the DF staging measure (eta(2) range, 0.02-0.18). All staging algorithms demonstrated predictive validity (eta(2) range, 0.04-0.126). CONCLUSION: Staging measures can determine motivational readiness for overweight women, contribute to the standardization of stage of change assessment and facilitate cross-study comparisons.

Behavioral treatment for smokers with a history of alcoholism: predictors of successful outcome.

This study examined baseline predictors associated with smoking abstinence among 205 smokers (113 men, 92 women) with a past history of alcoholism. Their mean age was 41.8 years, and 93% were Caucasian. Participants were randomly assigned to standard treatment (ST), behavioral counseling plus exercise (BEX), or behavioral counseling plus nicotine gum (BNIC). Factors multivariately associated with point-prevalence smoking abstinence at posttreatment (1 week after target quit date) were a longer duration of prior smoking abstinence and an interaction between treatment group and having an active 12-step sponsor. ST was more effective for those with an active sponsor, whereas both BEX and BNIC were more effective for those without an active sponsor. At 1-year follow-up, independent predictors of point-prevalence smoking abstinence were a lower Fagerström Tolerance Questionnaire score (K. O. Fagerström, 1978) and fewer years of smoking.

A multicomponent program for nutrition and physical activity change in primary care: PACE+ for adolescents.

BACKGROUND: Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. PARTICIPANTS: Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. INTERVENTION: Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. MEASURES: Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. RESULTS: All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. CONCLUSIONS: A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Six-month patient outcomes in a preventive cardiology center.

More effective ways to improve lifestyle behaviors need to be developed. Two hundred forty adult patients at a preventive cardiology clinic were randomly assigned to receive either one or five sessions of behavioral instruction to improve cardiovascular risk behaviors. Results for 102 patients from 6-month follow-up data revealed few significant differences between the two groups. However, in the two groups combined, there were significant reductions in total calories, percent of calories from total fat, percent of calories from saturated and monounsaturated fat, and dietary cholesterol. Reductions were also found in systolic blood pressure, triglycerides, body mass index, and weight. In multiple regression analyses, changes in physiologic variables were primarily associated with baseline and demographic characteristics. Changes in total calories, percent of calories from polyunsaturated fat, and walking were predicted by changes in social support or knowledge. Although most patients improved, the intensity of behavior change instruction was not related to the amount of change in cardiovascular risk factors. (c) 2001 by CHF, Inc.

Effects of a physical activity intervention on body image in university seniors: project GRAD.

Project GRAD (Graduate Ready for Activity Daily) was a randomized controlled study to teach university seniors behavioral skills necessary for increasing and/or maintaining physical activity habits in preparation for the transition to working adult roles after graduation. This study examines the secondary effects of this intervention on body image concerns among college-aged men and women. Three hundred thirty-eight undergraduates (54%female, Mage = 24years, SD = 1.95; MBody Mass Index = 24.26, SD = 4.0) were studied. The sample was 61/% Anglo, 16% Latino, 16% Asian/Pacific Islander, 4% African American, and 3% Native American/Other Body image concerns were assessed at pre- and posttreatment using 2 subscales of the Eating Disorder Inventory: Drive for Thinness and Body Dissatisfaction. Because the latter concentrates on body parts typically associated with female concerns (e.g., thighs, hips, buttocks), a parallel scale was developed to target body parts that may be of more concern to men (e.g., legs, shoulders, arms, stomach). Results indicated that compared to the control group, women in the intervention showed a significant increase in drive for thinness without any changes in body dissatisfaction. For men, there were no significant changes in drive for thinness or body dissatisfaction. These results suggest that physical activity interventions may have some negative consequences of increasing concerns about thinness in women. This negative effect occurred despite intervention content designed to prevent concern over eating, dieting, and the importance of weight. Health promotion studies should include assessments of potential negative side effects.

Impact of a worksite behavioral skills intervention.

Sixty-four male and female sedentary employees were randomly assigned to an intervention group or control group to determine the effects of behavioral skill training on adoption and maintenance of exercise. Both received a 9-month membership at a local fitness facility. The control group received a 12-week semistructured course, which included a facility orientation and three meetings with a personal trainer. The intervention group received a 12-week behavioral skills course and were encouraged to participate in a 12-week semistructured exercise course followed by a 3-month problem-solving support intervention. Both groups improved their daily energy expenditure, the amount of moderate and vigorous activity they performed, and their strength and flexibility. The study sample was too small to show substantial differences between the intervention and control group. Changes in mediator variables were mixed.

Examination of the factor structure of physical activity behaviors.

Multiple physical activity recommendations exist for behaviors that vary in type and intensity (e.g., vigorous physical activity, strengthening exercises, moderate physical activity). The present study examined underlying dimensions of physical activity behaviors and determined the extent to which factors correspond to national health recommendations. Fifteen variables were drawn from six self-report measures and subjected to factor analysis with quartimax rotation. Participants were 547 university seniors (56% female; 60% Caucasian; mean age = 25 years). TV watching, the only index of sedentary behavior, did not load highly with other items, and was analyzed separately. Three interpretable factors were found: variables related to vigorous physical activity loaded highly on Factor 1; flexibility and strengthening items loaded highly on Factor 2; and moderate and housework activity loaded highly on Factor 3. Factors corresponded closely to national recommendations. Unweighted factor scores and TV watching correlated significantly with physiological indicators of fitness, supporting construct validity.

PACE+: interactive communication technology for behavior change in clinical settings.

BACKGROUND: Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults. METHODS: The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers. RESULTS: The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified. CONCLUSIONS: Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.

Effect of three smoking cessation treatments on nicotine withdrawal in 141 abstinent alcoholic smokers.

This prospective study examined the effect of three behavioral smoking interventions and reductions in cigarettes smoked per day on nicotine withdrawal symptoms in 141 abstinent alcoholic smokers (73 men, 68 women). The participants' mean +/- SD age was 41.4 +/- 9.2 years. They smoked an average of 27.7 +/- 12.1 cigarettes per day and reported 4.1 +/- 4.3 years of current abstinent from alcohol and other drugs of dependence. Participants were randomly assigned to a 12-week program of standard treatment (ST, n = 61), behavioral counseling plus exercise (BEX, n = 39), or behavioral counseling plus nicotine gum (BNIC, n = 41). All three conditions included instructions to reduce the number of cigarettes smoked per day prior to the target quit date (TQD). The TQD was week 4 for ST subjects and week 8 for those in the BEX and BNIC groups. The post-treatment assessment occurred one week after TQD. The Profile of Mood States (POMS) and the Beck Depression Inventory were administered at baseline and posttreatment to assess nicotine withdrawal. Significant increases were detected for the POMS total mood disturbance score, and the depression, tension, anger and confusion subscales, while vigor scores decreased (all p < 0.03). Withdrawal change scores were not found to be associated with treatment condition or percentage reduction in cigarettes, and there was no evidence of a significant interaction of treatment and cigarette reduction. Results are discussed in relation to implications for treatment and for future research.

Practical nutrition assessment in primary care settings: a review.

BACKGROUND: Poor dietary and physical activity habits account for 300,000 deaths per year. Interventions in the primary care setting offer promise for effecting change on a broad scale. However, to conduct counseling, primary care providers need quick, accurate, and efficient assessment tools that are practical for a health care setting. METHODS: We reviewed 18 dietary measures for use in primary care that were brief (less than 50 items) and easy to administer, score, and interpret. The macronutrients assessed by the measure and the psychometric properties, if given, are reported. RESULTS: In general, reliability and validity coefficients were slightly lower than more detailed instruments (i.e., food frequency questionnaires, diet recall); however, they are acceptable within this clinical setting. CONCLUSIONS: Providers can benefit from using these tools to assess current dietary patterns and to guide patient counseling. Future measures should focus on additional nutritional topics (e.g., calcium deficiency) and sensitivity to change over time.

Project GRAD: two-year outcomes of a randomized controlled physical activity intervention among young adults. Graduate Ready for Activity Daily.

INTRODUCTION: Project Graduate Ready for Activity Daily evaluated a program to promote physical activity through the transition of university graduation in a randomized controlled trial. METHODS: Three hundred thirty-eight university seniors participated in either a cognitive-behavioral intervention course or a knowledge-oriented general health course during the semester before graduation. Behaviorally oriented phone and mail follow-up was delivered to the intervention group for 18 months. Physical activity outcomes and mediating variables were assessed at baseline, 1 and 2 years (93% retention rate). RESULTS: There were no significant intervention effects on physical activity outcomes at 2 years for either men or women. Experiential and behavioral processes of change were significantly improved for intervention women over 2 years. CONCLUSIONS: Despite excellent participation in a theoretically based, well-attended intervention, few long-term effects on physical activity or its mediators were found. Additional research is needed to determine optimal interventions for physical activity and to validate or alter current behavior change theory.

Assessment of physical activity with the Computer Science and Applications, Inc., accelerometer: laboratory versus field validation.

Our purpose was to compare the validity of the Computer Science and Applications, (CSA) Inc., accelerometer in laboratory and field settings and establish CSA count ranges for light, moderate, and vigorous physical activity. Validity was determined in 60 adults during treadmill exercise, using oxygen consumption (VO2) as the criterion measure, while 30 adults walked and jogged outdoors on a 400-m track. The relationship between CSA counts and VO2 was linear (R2 = .89 SEE = 3.72 ml.kg-1.min-1), as was the relationship between velocity and counts in the field (R2 = .89, SEE = 0.89 mi.hr-1). However, significant differences were found (p < .05) between laboratory and field measures of CSA counts for light and vigorous intensity. We conclude that the CSA can be used to quantify walking and jogging outdoors on level ground; however, laboratory equations may not be appropriate for use in field settings, particularly for light and vigorous activity.

Self-report measures and scoring protocols affect prevalence estimates of meeting physical activity guidelines.

PURPOSE: Prevalence estimates of meeting the guidelines for physical activity based on various self-report measures were compared, and the effects of various scoring protocols on the estimates were evaluated. METHOD: A sample of 575 university students aged 24.5 +/- 1.9 yr (56% women, 54% Euro-American) completed the Seven-Day Physical Activity Recall interview (PAR), Youth Risk Behavior Survey (YRBS), and National Health Interview Survey 1991 (NHIS). To determine the prevalence of meeting the ACSM (1990) fitness and the CDC/ACSM (1995) health-related guidelines, various scoring protocols were employed that closely approximated the recommendations. Protocols varied by whether frequency and duration or duration only were considered. For the health-related guidelines, scoring protocols also varied depending on the intensity of activities considered. RESULTS: Depending on the scoring protocol and instrument used, the proportion meeting the fitness guidelines ranged from 32 to 59%. The NHIS, YRBS, and PAR resulted in significantly different proportions of those meeting the health-related guideline, ranging from 4 to 70%. CONCLUSION: The type of measure as well as the scoring protocol affected prevalence estimates of meeting the physical activity guidelines. This study indicates the difficulty of comparing prevalence rates across studies using different measures.

Potential mediators of change in a physical activity promotion course for university students: Project GRAD.

The purpose of the study is to evaluate the performance of theoretically-derived mediators of health behavior change. Participants were university seniors (184 females; 154 males) randomly assigned to an intervention course designed to promote physical activity or to a control course. Five physical activity outcomes and nine psychosocial mediating variables were assessed at baseline and the end of the 16-week course. For women, the intervention had significant effects on five of the mediators, including self-efficacy for making time, self-efficacy for resisting relapse, social support from friends, and experiential and behavioral processes of change. Among men, the intervention improved use of behavioral processes of change but also had the unintended effect of increasing perceived barriers to activity. For women, significant contributors to regressions explaining physical activity change were social support from friends (for total activity) and change in self-efficacy for resisting relapse (for vigorous exercise). For men, significant explanatory variables included change in enjoyment (for total activity), change in self-efficacy for resisting relapse (for strength exercise), and change in benefits (for moderate intensity activity). For both sexes, there were significant findings in the unexpected direction. Across the five physical activity outcomes, hypothesized mediators were inconsistent and weak contributors to the models. Investigating mediators of behavior change has the potential to stimulate improvements in theories and interventions.

Psychosocial and demographic correlates of television viewing.

PURPOSE: The present study was grounded in the notion that previously identified physical activity determinants were associated in reverse with television viewing. Identifying demographic and psychosocial correlates and other potential determinants of television viewing may allow for the development and conceptualization of models and interventions to reduce sedentary behavior. DESIGN: Cross-sectional data from self-report measures were analyzed using multiple hierarchical regression. SETTING: Data were collected from 1995 to 1996 on seniors attending a large public university in southern California. SAMPLE: Subjects were 321 female and 255 male university seniors attending a public university in southern California. The sample's ethnic distribution was 53.8% European-American, 16.3% Latino, 16.6% Asian/Pacific Islander, 16.1% African-American, and 4.3% other. MEASURES: Typical television viewing practices on weekdays and weekends were assessed using self-report items. Physical activity determinants were assessed using self-report measures derived from social cognitive theory and the transtheoretical model of behavior change. RESULTS: The variables explaining a significant amount of variance after controlling for ethnicity and employment status in females were barriers to physical activity (p < .05), body image dissatisfaction (p < .01), and processes of change (p < .02). The entire model for females captured 16% of the variance, with the psychosocial variables accounting for 8% of the variance. The significant variables in the male model were quality of life (p < .01) and grade point average (p < .03). The full model accounted for 15% of the variance, with nondemographic variables accounting for 5% of the variance in television viewing. CONCLUSIONS: Relationships between television viewing and potential determinants were found. However, additional variables that may influence the amount of television viewing need to be conceptualized and investigated.

Validity, reliability, and calibration of the Tritrac accelerometer as a measure of physical activity.

PURPOSE: The purposes of this study were to assess the validity and reliability of the Tritrac R3D accelerometer during treadmill walking and running and then to calibrate the instrument. METHODS: The Tritrac was assessed on 60 young adults (23.4 +/- 2.9 yr) during treadmill walking and running at 3.2, 6.4, and 9.7 km x h(-1). The calibration was carried out by identifying ranges of Tritrac raw data (vector magnitude) values corresponding to light (2-3.9 MET), moderate (4-7 MET), and vigorous (>7 MET) physical activity. Energy expenditure (EE), measured by indirect calorimetry, served as the criterion measure. RESULTS: Interinstrument intraclass reliability coefficients for Tritracs worn on the right and left hip ranged from 0.73-0.87, while intersession coefficients demonstrated high reliability for all speeds (R = 0.87-0.92). Paired t-tests comparing mean accelerometer counts at 6.4 km x h(-1), 0% grade (2647 +/- 456), and 6.4 km x h(-1), 5% grade (2635 +/- 435) demonstrated no significant difference (P > 0.05). Mean differences between EE measured by indirect calorimetry and that estimated by the Tritrac ranged from 0.0082 kcal x kg(-1) x min(-1) at 3.2 km x h(-1) to 0.0320 kcal x kg(-1) x min(-1) at 9.7 km x h(-1), with the Tritrac consistently overestimating EE during horizontal treadmill walking. The relationship between vector magnitude and EE across all speeds was highly linear (R2 = 0.90, SEE = 0.014 kcal x kg(-1) x min(-1)), with little overlap between light, moderate, and vigorous categories. The mean vector magnitudes at 2, 4, and 7 MET were 650, 1772, and 3455, respectively. CONCLUSIONS: These data indicate that the Tritrac is highly reliable from day to day and is sensitive to changes in speed but not grade. Furthermore, the Tritrac accurately distinguishes various intensities of walking and jogging on level ground. With limitations, these cut-points can be used to categorize light, moderate, and vigorous physical activity and to estimate EE.

Evaluation of a university course to promote physical activity: project GRAD.

Project GRAD (Graduate Ready for Activity Daily) evaluates a university course to promote physical activity. In a randomized study, 338 university seniors participated in either an intervention or control course for academic credit, and posttest data were collected on 321. The control course was knowledge-oriented. The intervention course taught behavior change skills in weekly lectures and peer-led labs. Physical activity was assessed with 7-Day Physical Activity Recall interviews. The intervention had no significant effects on men. Among women, the intervention increased total physical activity during leisure, strengthening exercises, and flexibility exercise. This university course had the intended effects of promoting healthful patterns of physical activity among women, but no effects were observed on men, who were more active than women at baseline.

Effects of interventions in health care settings on physical activity or cardiorespiratory fitness.

INTRODUCTION: This paper reviews studies of physical activity interventions in health care settings to determine effects on physical activity and/or fitness and characteristics of successful interventions. METHODS: Studies testing interventions to promote physical activity in health care settings for primary prevention (patients without disease) and secondary prevention (patients with cardiovascular disease [CVD]) were identified by computerized search methods and reference lists of reviews and articles. Inclusion criteria included assignment to intervention and control groups, physical activity or cardiorespiratory fitness outcome measures, and, for the secondary prevention studies, measurement 12 or more months after randomization. The number of studies with statistically significant effects was determined overall as well as for studies testing interventions with various characteristics. RESULTS: Twelve studies of primary prevention were identified, seven of which were randomized. Three of four randomized studies with short-term measurement (4 weeks to 3 months after randomization), and two of five randomized studies with long-term measurement (6 months after randomization) achieved significant effect on physical activity. Twenty-four randomized studies of CVD secondary prevention were identified; 13 achieved significant effects on activity and/or fitness at twelve or more months. Studies with measurement at two time points showed decaying effects over time, particularly if the intervention were discontinued. Successful interventions contained multiple contacts, behavioral approaches, supervised exercise, provision of equipment, and/or continuing intervention. Many studies had methodologic problems such as low follow-up rates. CONCLUSION: Interventions in health care settings can increase physical activity for both primary and secondary prevention. Long-term effects are more likely with continuing intervention and multiple intervention components such as supervised exercise, provision of equipment, and behavioral approaches. Recommendations for additional research are given.