A placebo controlled randomized trial of the effects of phenylpropanolamine and nicotine gum on cessation rates and postcessation weight gain in women.

With smoking prevalence rates beginning to decline, studies designed to promote cessation in more challenging populations, like weight-concerned smokers, warrant attention. This study assessed the efficacy of two forms of pharmacotherapy [nicotine and phenylpropanolamine (PPA) gums] in addition to a 13-week cognitive behavioral smoking cessation program targeted for women. Participants were 439 females who met rigorous screening criteria and were randomized to one of the three treatment intervention groups (PPA gum, nicotine gum, or placebo gum). All participants attended a 13-week cognitive behavioral smoking cessation program and were given specific instructions on gum chewing. At posttest (13 weeks), and 6- and 12-month follow-ups, body weight and point prevalence abstinence were assessed. Analyses to determine potential differences between treatment groups on weight change and cessation rates were performed. Results indicated that neither change in body weight nor cessation rates significantly differed between groups. Attendance to sessions did appear to consistently increase the likelihood of quitting smoking at posttest and at each of the follow-ups. These results suggest that although the pharmacological interventions had no effect on cessation rates and postcessation weight gain, the behavioral component of the intervention was effective in increasing the odds of quitting smoking in weight-concerned women. Future efforts should focus on increasing adherence to behavioral program components, particularly session attendance.

Reliability and validity of a brief questionnaire to assess calcium intake in female collegiate athletes.

Calcium intake often is inadequate in female collegiate athletes, increasing the risk for training injuries and future osteoporosis. Thus, a brief and accurate assessment tool to quickly measure calcium intake in athletes is needed. We evaluated the reliability and validity, compared to 6 days of diet records (DRs), of the Rapid Assessment Method (RAM), a self-administered calcium checklist. Seventy-six female collegiate athletes (mean age = 18.8 yrs, range= 17- 21; 97 % Caucasian) were recruited from basketball, cross-country, field hockey, soccer, and volleyball teams. Athletes completed a RAM at the start of the training season to assess calcium intake during the past week. Two weeks later, a second RAM was completed to assess reliability, and athletes began 6 days of diet records (DRs) collection. At completion of DRs, athletes completed a final RAM, corresponding to the same time period as DRs, to assess agreement between the 2 instruments. The RAM demonstrated adequate test-retest reliability over 2 weeks (n= 56; Intraclass correlation [ICC] = 0.54, p < 0.0001) and adequate agreement with DRs (n = 34; ICC = 0.41, p = 0.0067). Calcium intake was below recommended levels, and mean estimates did not differ significantly on the RAM (823 +/- 387 mg/d) and DRs (822 +/- 330 mg/d; p = 0.988). Adequacy of calcium intake from both DRs and the RAM was classified as "inadequate" (<1000 mg/d) and "adequate" (> or = 1000 mg/d). Agreement between the RAM and DRs for adequacy classification was fair (ICC= 0.30, p = 0.042), with the RAM identifying 84% of athletes judged to have inadequate calcium intake based on DRs. The RAM briefly and accurately estimates calcium intake in female collegiate athletes compared to DRs.

Relationships among smoking status, ethnicity, socioeconomic indicators, and lifestyle variables in a biracial sample of women.

BACKGROUND: Smoking prevalence rates remain high among women and smoking initiation has increased for young adults. Little is known about the unique patterns of smoking, risk factors, and correlates of quitting in Black versus White women of child-bearing age. METHOD: This study examined the relationships among smoking, ethnicity, socioeconomic status (SES), and lifestyle variables among 715 women (43.6% Blacks and 56.4% Whites). Stringent inclusion criteria were used for ethnicity, which allows for distinct comparisons but may reduce generalizability of results. RESULTS: Black current smokers smoked fewer cigarettes per day and reported initiating smoking at a later age than Whites. Current versus never smoking was associated with income, education, and caffeine intake. There was a significant ethnicity by alcohol interaction (at lower levels of alcohol intake Whites were more likely to smoke but at higher levels of alcohol there were no ethnic differences). Former smoking versus current smoking was associated with alcohol intake, education, and pack years of smoking. CONCLUSIONS: The results of the study suggest several ethnic differences in smoking patterns as well as several correlates of smoking status. These results have implications for the tailoring of interventions and illustrate the association of other health risk factors with smoking status.

Predicting energy expenditure of physical activity using hip- and wrist-worn accelerometers.

To investigate the association between physical activity and health, we need accurate and detailed free-living physical activity measurements. The determination of energy expenditure of activity (EEACT) may also be useful in the treatment and maintenance of nutritional diseases such as diabetes mellitus. Minute-to-minute energy expenditure during a 24-h period was measured in 60 sedentary normal female volunteers (35.4 +/- 9.0 years, body mass index 30.0 +/- 5.9 kg/m2), using a state-of-the-art whole-room indirect calorimeter. The activities ranged from sedentary deskwork to walking and stepping at different intensities. Body movements were simultaneously measured using a hip-worn triaxial accelerometer (Tritrac-R3D, Hemokentics, Inc., Madison, Wisconsin) and a wrist-worn uniaxial accelerometer (ActiWatch AW64, MiniMitter Co., Sunriver, Oregon) on the dominant arm. Movement data from the accelerometers were used to develop nonlinear prediction models (separately and combined) to estimate EEACT and compared for accuracy. In a subgroup (n=12), a second 24-h study period was repeated for cross-validation of the combined model. The combined model, using Tritrac-R3D and ActiWatch, accurately estimated total EEACT (97.7 +/- 3.2% of the measured values, p=0.781), as compared with using ActiWatch (86.0 +/- 4.7%, p<0.001) or Tritrac-R3D (90.0 +/- 4.6%, p<0.001) alone. This model was also accurate for all intensity categories during various physical activities. The subgroup cross-validation also showed accurate and reproducible predictions by the combination model. In this study, we demonstrated that movement measured using accelerometers at the hip and wrist could be used to accurately predict EEACT of various types and intensity of activities. This concept can be extended to develop valid models for the accurate measurement of free-living energy metabolism in clinical populations.

Medical costs are reduced when children with intractable epilepsy are successfully treated with the ketogenic diet.

The ketogenic diet is used for children with drug refractory epilepsies. Although this diet was developed early in the 20th century, its use was infrequent until recently. One of the concerns about the ketogenic diet is the cost of initiating the diet. The process generally involves an inpatient visit that can last several days. In this study, the health care costs for 15 children with drug refractory epilepsy who received their care at Vanderbilt University Medical Center were compared for the period of time 6 to 12 months before they began the ketogenic diet and 6 to 12 months after they began the ketogenic diet. All comparisons within each child were done on the same amount of time before and after initiation of the diet. Total costs affiliated with care for the 15 children were: $352,820.20 for the prediet period, $41,221.91 for the diet initiation, and $149,436.86 for the postdiet-initiation period. We conclude that successful maintenance on the ketogenic diet provides a substantial financial benefit.