Characteristics of highly physically active smokers in a population of young adult military recruits

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.

Cigarette smoking is associated with energy balance in premenopausal African-American adult women differently than in similarly aged white women

OBJECTIVE

To investigate the differential association of cigarette smoking with energy balance in African-American and white premenopausal women.

DESIGN

Cross-sectional study of energy balance, weight, and smoking in women.

SUBJECT

A total of 374 women: 191 African-American (mean age=29.8+/-6.5 y) and 183 white women (mean age=28.9+/-7.1 y).

MEASUREMENTS

Weight, cigarette smoking habits, resting energy expenditure, dietary intake, and physical activity.

RESULTS

There were no significant differences in dietary intake by race or smoking status. The model for physical activity was significant (P=0.0004), with body mass index (BMI) having the largest effect on activity (P<0.001). Smoking status was related to activity, with the heaviest smokers reporting more activity than nonsmokers (P=0.008) or light smokers (P=0.028). The model for resting energy expenditure (REE) was significant (P<0.0001), with the largest again being BMI (P<0.001). There was also an interaction between ethnicity and smoking status (P<0.0001) such that African-American nonsmokers and light smokers tended to have lower REE than several other groups, most often the African-American moderate heavy smokers. The model for BMI was significant (P<0.0001) with an interaction for ethnicity and smoking status (P=0.0009). African-American nonsmokers and light smokers had significantly higher BMIs than most of the other groups.

CONCLUSION

African-American women who were the heaviest smokers had a lower adjusted BMI than the heaviest smoking white women. This effect, at least partially, may be related to an increased REE in the African-American smoking women. While energy intake did not appear to be important in this relationship, energy expended in physical activity appeared to be increased with smoking, as was REE.

The reliability and predictive value of adolescents' reports of initial reactions to smoking

A sample of 372 adolescents completed annual surveys regarding their initial reactions to smoking (IRTS) and their current smoking status. Each annual survey asked participants if they had the following five reactions the first time they smoked a cigarette: coughing, or feeling dizzy, sick, high, or relaxed. Time 1 IRTS data were collected within 1 year of the reported initial smoking experience, and Time 2 IRTS data were collected 1 year later. Kappa values for two IRTS items, coughing (.45) and dizziness (.40), indicated modest but acceptable reliability across a 1-year period, but the remaining items showed poor reliability (all < or =.31). Logistic regression analyses indicated that no IRTS item significantly predicted regular (at least weekly) smoking 1 year later. However, when IRTS and smoking status were assessed concurrently (at Time 2), reports of feeling relaxed and not coughing during the initial episode were significantly correlated with regular smoking. Participants who progressed from experimental to regular smoking from Time 1 to Time 2 were more likely to report relaxation as an initial reaction to smoking at Time 2 after denying relaxation at Time 1.

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.

Common design elements of the Girls health Enrichment Multi-site Studies (GEMS)

The Girls health Enrichment Multi-site Studies (GEMS) was a multi-center research program created for the purpose of testing interventions designed to prevent excess weight gain by African-American girls, as they enter and proceed through puberty. However, GEMS was not a "multi-center clinical trial" in the usual sense. Although these studies applied similar eligibility criteria, observed a similar follow-up schedule, and followed a similar measurement protocol, important differences existed, as well. Each field center developed its own intervention(s) and corresponding control, and tailored its study to the specific hypothesis being tested. Therefore, the study populations were somewhat different, with recruitment strategies that varied accordingly, and supplemental evaluations appropriate to the specific interventions were conducted on a site-specific basis. The purpose of this paper is to describe the common design elements of the GEMS Phase 1 pilot studies. This report presents the basic study design, a brief overview of the interventions, the measurements taken and their rationale, and procedures both for compiling the collaborative database, and performing site-specific analyses.

Child- and parent-targeted interventions: the Memphis GEMS pilot study

OBJECTIVE

To assess the feasibility, acceptability, and outcomes of 2 versions of a culturally relevant, family-based intervention to prevent excess weight gain in pre-adolescent African-American girls.

DESIGN

Three-arm, 12-week parallel group randomized controlled pilot trial.

SETTING

Community centers in Memphis, Tennessee.

PARTICIPANTS

Sixty African-American girls, aged 8 to 10 years, with a body mass index (BMI) > or = 25th percentile of the CDC growth charts, along with their parents/caregivers.

INTERVENTIONS

The active interventions involved highly interactive weekly group sessions with either girls (child-targeted program) or parents/caregivers (parent-targeted program). Content focused on knowledge and behavior change skills to promote healthy eating and increased physical activity. The comparison intervention focused on global self-esteem.

MAIN OUTCOME MEASURES

Given the lack of power and the limited time frame of the pilot study, outcomes were evaluated on the basis of implementation measures and changes in physical activity (accelerometer data), and in consumption of sweetened beverages and water, as estimated from questionnaires. Changes in body mass index, waist circumference, and body composition were also examined.

RESULTS

The Memphis GEMS pilot intervention met all recruitment, retention, implementation, and participation goals, and was given high rating by both participants and interventionists. With respect to the comparison intervention, girls in both the child-targeted and parent-targeted interventions demonstrated a trend toward reduced body mass index and waist circumference. In addition, girls in the active intervention groups reduced their consumption of sweetened beverages by 34%, increased their level of moderate-to-vigorous activity by 12%, and increased their serving; of water by 1.5%.

CONCLUSIONS

The findings from this pilot study demonstrated the feasibility, perceived acceptability, and efficacy of culturally relevant, obesity prevention interventions for pre-adolescent African-American girls and their parents/caregivers.

Rapid progression to regular cigarette smoking among nonsmoking adolescents: interactions with gender and ethnicity

BACKGROUND

While the correlates and predictors associated with transition through the stages of smoking acquisition have received substantial attention, the identification of factors associated with the time course of progression remain generally unexplored.

METHODS

We identified adolescents escalating from nonsmoking to regular smoking in 1 year as rapid progressors (n = 98) and those escalating from nonsmoking to experimental smoking in 1 year as slow progressors (n = 555). We entered demographic and psychosocial variables, initial reactions to smoking variables, and their interactions with gender and ethnicity into a logistic regression analysis comparing rapid progressors to slow progressors.

RESULTS

At baseline, rapid progressors reported more friends who smoked regularly. Girls who reported more concern with dieting and less social success were more likely to progress to regular smoking within 1 year; these variables did not influence progression in boys. Those who associated positive feelings with their initial smoking experience were more likely to progress to regular smoking. Differences between white and African American youth emphasize the importance of physiological interpretations of initial smoking experiences.

CONCLUSIONS

Our findings suggest that even as nonsmokers, adolescents likely to progress quickly to regular smoking can be identified. Researchers designing prevention programs should take these factors into account.

A prospective evaluation of the relationships between smoking dosage and body mass index in an adolescent, biracial cohort

Although there is clearly an inverse relationship between smoking and body weight, recent studies suggest that weight attenuation via smoking is slow and may take decades to accrue. This investigation prospectively evaluated the relationships between smoking dosage (or lack thereof) and relative weight change in 1697 adolescents followed over 4 years. A 4 (smoking groups: 0, 1, 2, or 3 or more years of smoking exposure)x2 (ethnicity: Caucasian or African American)x2 (gender: male or female) analysis of variance (ANOVA) was performed to assess weight gain attenuation associated with increasing exposure to smoking. The overall results revealed a significant three-way interaction between smoking dosage, gender, and ethnicity. Specifically, smoking initiation was associated with an increase in body mass index (BMI) for 2 years after initiation. For those youth smoking 3 or more years, body weights were almost identical compared to never-smokers. No significant reductions in body weight were observed in any gender or ethnic group for up to 3 years after smoking initiation. It is concluded that smoking initiation is not associated with adolescent body weight change for at least a 3-year period.

Ethnic differences in smoking withdrawal effects among adolescents

Smoking withdrawal effect information was collected from 75 adolescents (54 males and 21 females) making a quit attempt during a school-based smoking cessation program. A strong need to smoke was the most common withdrawal effect (60%), followed by irritability (51%), and difficulty concentrating (41%). Most (61%) participants experienced two or more withdrawal effects during the quit attempt, and withdrawal effects were evident in those smoking less than daily. Significant ethnic differences were found, with African Americans reporting significantly fewer withdrawal effects than Caucasians. After controlling for smoking frequency, African Americans were still less likely to report irritability, difficulty concentrating, and restlessness. Participants who chose to use nicotine replacement during the quit attempt were more likely to report difficulty concentrating, restlessness, and feeling miserable.

Characteristics of adolescents caught with cigarettes at school: implications for developing smoking cessation programs

A potential method of recruiting adolescents for smoking cessation interventions is to offer treatment to students who have been caught with cigarettes at school. The present investigation surveyed 110 adolescents after they were caught with cigarettes at school. The majority of participants were daily smokers (65%) and 17% of the sample scored > or =6 on a version of the Fagerström Tolerance Questionnaire. Smoking was pervasive in their social environment, with approximately half the sample reporting that all five of their five best friends smoked. Interest in quitting was evident. Most had made a quit attempt during the past year (71%) and two-thirds planned to quit within the next 6 months. However, questionable strategies (e.g., increasing caffeine consumption) had been used during previous quit attempts. The implications for developing school-based smoking cessation programs are discussed.

Side-to-side comparisons of bone mineral density in upper and lower limbs of collegiate athletes

This cross-sectional study investigated the effects of participation in various sports on side-to-side (contralateral) differences in bone mineral density (BMD) of the upper and lower limbs. The BMD of the arms and legs was measured using dual energy X-ray absorptiometry. The subjects were 184 collegiate athletes, both men and women, who participated in NCAA Division I-A baseball, basketball, football, golf, soccer, tennis, cross-country, indoor/outdoor track, and volleyball. Results revealed greater BMD of the right arms compared with the left arms for all teams, with the most pronounced differences observed in men's and women's tennis and men's baseball. Differences in the lower limbs were less common. No significant differences in lower limb BMD were found in the women. In men, differences in lower limb BMD were found in the football and tennis teams, with the nondominant leg having greater bone mass. Recognition of contralateral differences in bone density may be of particular interest to strength and conditioning professionals as they consider the need to include bilateral and unilateral training programs in an effort to maximize performance and minimize stress-related injuries.

What motivates adolescent smokers to make a quit attempt?

A sample of 120 adolescent smokers (80 males, 40 females), most of whom were referred by school personnel after being caught with cigarettes at school (n=113), reported motivations for making a quit attempt during a smoking cessation project. Most students (n=76) were randomly assigned to a four session cessation program that included discussion of a number of motivational topics, and the remaining students were assigned to a self-help control group that received a pamphlet recommending strategies for quitting. Reported motivations for quitting did not differ significantly across the two treatment conditions. Concern about future health (73%) was the most popular reason given for making a quit attempt, followed by concern about current health (65%). Concerns about physical appearance (59%), the cost of cigarettes (52%), and athletic performance (51%) were also listed as motivators by a majority of the participants. Future health was the most popular choice for the most important motivator to quit (35%). Females and participants with fewer best friends smoking were more likely to report that the prevalence of non-smoking teenagers, the relationship between smoking and weight, and physical appearance concerns were motivators to quit. African Americans were more likely than Whites to list current health concern as the most important motivator.

Are overweight and obese airmen at greater risk of discharge from the United States Air Force?

This study examined whether overweight or obesity results in greater discharge risk from basic military training (BMT) or during the first year of service in the U.S. Air Force (USAF). Participants were 32,144 male and female airmen who underwent BMT from August 1995 to August 1996 and were classified as underweight (body mass index [BMI] < 18), normal range (BMI = 18-24.9), overweight (BMI = 25-29.9), or obese (BMI > or = 30). Underweight airmen were 63% more likely and overweight airmen were 24% more likely to be medically discharged during BMT compared with individuals in the normal range. Underweight airmen were 22% more likely to be discharged within the first year of service compared with those in the normal range, whereas overweight airmen were 15% less likely to be discharged. These findings do not support overweight or obesity as being major causes for discharge from the USAF within the first year of active duty.

Bone mineral density in triathletes over a competitive season

There is evidence from previous cross-sectional studies that high volumes of certain sports, including running, swimming and cycling, may have a negative impact on bone mineral density. The aim of the present study was to evaluate prospectively the effects of high athletic training in individuals who engage in high volumes of all three of these activities (triathletes). Bone mineral density for the total body, arms and legs was determined by dual-energy X-ray absorptiometry in 21 competitive triathletes (9 men, 12 women) at the beginning of the training season and 24 weeks later. Age, body mass index, calcium intake and training volume were also recorded to examine potential mediators of bone mineral density change. Men had greater bone mineral density at all sites than women. No significant changes were observed over the 24 weeks for either total body or leg bone mineral density. Bone mineral density in both arms increased by approximately 2% in men (P < 0.03), but no change was observed for women. Change in bone mineral density at all sites was unrelated to age, body mass index, calcium intake and training volume. The results suggest that adverse changes in bone mineral density do not occur over the course of 6 months of training in competitive triathletes.

Race, socioeconomic status, and perceived discrimination among healthy women

OBJECTIVES

Perceived discrimination and socioeconomic status (SES) have been found to be related to health problems. However, little is known about how SES and ethnicity relate to perception and responses to discrimination. This study examined the relationship between race and a set of SES indicators, perceived discrimination (race and gender), and responses to perceived discrimination among healthy women.

METHODS

The sample consisted of 460 women between the ages of 18 and 39 (194 black and 266 white). The independent variables included income, education, occupation, and race. The dependent variables included perceived discrimination (race/color and gender) and responses to unfair treatment.

RESULTS

Income and education were both directly related to perceived racial discrimination. However, the relationship between education and perceived discrimination was modified by race. For white women, only higher education was related to less perceived discrimination, and there was no significant difference across education levels for black women. Education was the only variable significantly associated with perceived gender discrimination (more highly educated women reported more discrimination). Occupation and race were both related to responses to perceived discrimination. Black women were significantly less likely to talk to someone when treated unfairly than white women (OR = 0.37, 95% confidence interval [CI] = 0.191, 0.716), and women in managerial/professional positions were significantly more likely to do something about being treated unfairly than women in service occupations (OR = 4.76, CI = 2.14, 10.61).

CONCLUSIONS

Our results suggest that both SES and race play important roles in women's perceptions of and responses to perceived discrimination.

Ethnic and gender differences in smoking and smoking cessation in a population of young adult air force recruits

PURPOSE

To examine gender and ethnic differences in smoking and smoking cessation in a population of young adult military recruits.

DESIGN

A self-administered survey of demographics, tobacco use, and other health risk behaviors was administered at the start of basic military training.

SETTING

The study was conducted at Lackland Air Force Base, San Antonio, Texas, where all U.S. Air Force recruits complete basic military training.

SUBJECTS

All recruits who entered the U.S. Air Force between September 1995 and September 1996 participated in this study (n = 32,144; 100% participation rate).

MEASURES

Recruits completed a written 53-item behavioral risk questionnaire. Measures examined in the present study included smoking status (ever having smoked a cigarette, current daily smoking, and quitting); demographics (ethnicity, gender, education, family income, and age); smoking history; and nicotine dependence.

RESULTS

Rates of ever smoking, current daily smoking, and quitting were examined in multiple logistic regression analyses as a function of gender and ethnicity, controlling for age, education, and family income. Overall, 54% of recruits had ever smoked a cigarette and 24.9% smoked daily at the time of entry into basic military training. Smoking rates were highest among white and Native American recruits. Among whites, women were more likely to be a current daily smoker (31.6% vs. 29.4%; odds ratio [OR] = 1.18, 99% confidence intervals [CI] = 1.08-1.29). The opposite pattern was observed among African-Americans (5.6% vs. 9.8%, respectively; OR = .57; CI = .41-.79). Current smokers had low levels of nicotine dependence compared with the general population of U.S. smokers, but whites tended to be more dependent than other ethnic groups. Cessation rates were similar for men and women but differed according to ethnicity, ranging from 15% among whites to 23% among Hispanics.

CONCLUSIONS

These findings document important gender and ethnic differences in cigarette smoking among military recruits. Whites and Native Americans were more likely to smoke, less likely to quit, and more nicotine-dependent than other ethnic groups. Across gender/ethnicity groups, smoking rates were especially high among white women, with nearly one-third smoking daily until entry into basic training. Gender differences were not observed in cessation rates, but Hispanics were more likely than other ethnic groups to have quit smoking. The results highlight the need to develop effective cessation interventions for this population.

Risk factors for smoking among adolescents with asthma

PURPOSE

To examine the prevalence of smoking among youth with asthma and explore potential risk factors for smoking among these youth, compared with youth without asthma.

METHODS

In March 1997, a questionnaire assessing risk factors for smoking was administered to students attending public high school in Memphis, Tennessee. The sample (n = 3234) ranged from 15 to 18 years of age, was predominately African-American (76.7%), and 56.7% female. Based on a single self-reported item, 15.7% of youth reported having asthma. Logistic regression analyses assessed asthma status differences in current smoking and the association between risk factors and smoking.

RESULTS

Nearly 20% of youth reported current smoking. Adolescents with asthma (current or past) were nearly 1.5 times more likely to smoke than peers without asthma. The association between risk factors and current cigarette smoking was equivalent for youth regardless of whether they had asthma and did not differ for those youth with current vs. past asthma.

CONCLUSIONS

Results suggest that adolescents with or without asthma smoke for similar reasons. Research is needed to elucidate whether there are unique risk factors, not examined here, for smoking among adolescents with asthma. Smoking prevention and cessation programs are needed for youth with asthma.

Adolescent reports of physician counseling for smoking

OBJECTIVE

Physicians can play an important role in reducing adolescent smoking by counseling their adolescent patients. The appropriate delivery of smoking prevention and cessation messages depends on adequate screening of adolescents, identification of smokers, and adolescents' willingness to disclose their smoking. The present study assessed adolescent reports of physician screening and counseling and adolescents' willingness to disclose smoking, as well as demographic and health status differences in these rates.

METHODS

Adolescents (n = 5016), ages 16 to 19, completed a survey on smoking and health. Reports of the prevalence of physician screening, counseling, and adolescents' willingness to disclose their smoking were examined, and logistic regression analyses assessed demographic and health status differences in these prevalence estimates.

RESULTS

Overall, 43.4% of the sample reported physician screening, 42.1% reported receiving counseling, and only 28.8% of adolescents reported both. Furthermore, 79.3% of smokers reported that they would admit their smoking if asked. Screening, counseling, and disclosure rates differed by gender, neighborhood income level, smoking status, and asthma status.

CONCLUSIONS

More intensive provider-delivered intervention is needed. Efforts should focus on helping providers to identify smoking correctly and to communicate appropriate prevention or cessation messages. Persistence and sensitivity with boys, experimental smokers, and youths with chronic health conditions should be a focus of provider training, because the lower willingness of these youths to disclose their smoking may be a barrier to their identification and intervention.

The relationship between socioeconomic status, ethnicity, and cigarette smoking in urban adolescents

BACKGROUND

This study examined the relationship between community-level and school-level socioeconomic status indicators and current cigarette smoking among urban adolescents, and examined whether the socioeconomic status-cigarette smoking relationship was similar for African Americans and Whites.

METHODS

Participants were 3,813 seventh-graders recruited in a large school system in the United States. Independent variables included median income and mean education within zip codes of participants' residence, percentage of participants receiving lunch at reduced or no cost at school level, and ethnicity. The dependent variable was current smoking status (never smoked vs smoking one or more cigarettes per month).

RESULTS

Whites were significantly more likely than African Americans to smoke cigarettes. There was a main effect of education and lunch at reduced or no cost on cigarette smoking. Mean education by zip code was inversely associated with cigarette smoking, and lunch at reduced or no cost was directly associated with cigarette smoking. There was a significant interaction between income and ethnicity. Median income by zip code was directly associated with cigarette smoking among African Americans.

CONCLUSIONS

Our findings suggest that smoking prevention efforts in this population should take both socioeconomic status and ethnicity into account.

History of sport participation in relation to obesity and related health behaviors in women

BACKGROUND

Organized sport participation in youth is a common form of physical activity; yet, little is known about how it is associated with adult obesity and related health behaviors. The purpose of this study was to investigate whether a history of youth sport participation was related to adult obesity, physical activity, and dietary intake among women.

METHODS

Participating women (209 African American, 277 Caucasian; ages 18-39), recruited from the community, completed laboratory measures, a paper and pencil survey assessing past sport participation and current physical activity level, and dietary records.

RESULTS

Linear regression revealed that a history of sport participation predicted lower adult body mass index and higher total and sport activity levels for both ethnic groups and higher work-related physical activity among Caucasians (all P < 0.001). Past sports participation did not predict dietary intake.

CONCLUSIONS

The results suggest that girls' participation in sports may lay the foundation for adult health and health behaviors and that sports participation could be an important component of obesity prevention programs.

Access to prenatal, delivery, and newborn care among undocumented Hispanics in the Memphis area

The purpose of this study was to examine the prenatal, delivery, and newborn care received by undocumented Hispanics in the Memphis area. The focus was to sketch a demographic profile of this population, identify barriers encountered in obtaining prenatal, delivery and newborn care, and present a five-year projection of the demand for prenatal care for this population. Participants included 97 undocumented Hispanic women, who either were pregnant or had a baby within the past 12 months, and health care providers. Most women came from Mexico (90.7%). They tended to be young, to have low educational attainment, to be homemakers, to have a high number of members in their households, to be financially supported by their spouses, and to live at or below the poverty line. The average length of time that they had been in the United States and Memphis were 42 and 21 months respectively. With regard to access to health care, undocumented Hispanics who migrated to the Memphis area lacked adequate prenatal and delivery care, and we estimated that the demand for prenatal care in this population will increase over 60% in the next five years.

Socioeconomic status, ethnicity, and health care access among young and healthy women

This study examined: (a) the relationship between socioeconomic status (SES) and health care access among healthy women; (b) which SES variable(s) were most strongly associated with HCA; and (c) whether the SES/HCA relationship was the same for Black and White women. A total of 383 women (57.4% Whites and 42.6% Blacks) participated in the study. Independent variables included family income, education levels, occupation, median income within zip code of participants' residence, and ethnicity. Dependent variables were the total and subscale scores (accessibility, accommodation, and affordability) on a measure of health care access. Family income was the SES variable that showed the strongest positive association with total health care access, and there was a significant interaction between occupation and ethnicity for total health care access. Unique relationships were observed between each SES variable and each subscale on the health care access measure. The overall patterns between SES and health care access were similar for Blacks and Whites. Results suggest that the relationship between health care access and SES should be investigated through a multi-dimensional approach, and that an array of SES variables must be considered when designing interventions to improve health care access among healthy women.

Food sources of calcium in a sample of African-American an Euro-American collegiate athletes

Adequate calcium intake is integral to bone health as well as for optimal athletic performance. This study was conducted to investigate: (a) food sources of calcium in a sample of collegiate athletes, (b) gender and/or ethnic differences in food sources of calcium, and (c) whether athletes that derive less of their calcium intake from dairy sources increase their calcium intake from supplements or other food sources. Participants were African-American and Euro-American NCAA Division 1-A athletes. Eighty-five men and 59 women participated. Calcium intake for the previous 7-day period was assessed with a brief calcium screen. Men consumed significantly more calcium than women (1,354 vs. 898 mg/day), with female cross-country runners exhibiting the lowest average intake (605 mg/day). Both men and women obtained the majority of their calcium from dairy products and mixed dishes, while men consumed significantly more calcium-fortified foods. Several gender and ethnic interactions for calcium intake from food groups were found. Mean total dairy calcium intake was found to vary according to total calcium intake in men, and supplemental calcium was not used to augment low dairy intakes of calcium in any group. While African-Americans and Euro-Americans athletes were consuming similar levels of calcium, the female athletes in the sample did not get adequate amounts.