Association between frailty and sleep quality in people living with multiple sclerosis and obesity: An observational cross-sectional study

BACKGROUND

A majority of the people with multiple sclerosis (pwMS) experience sleep disturbances. Frailty is also common in pwMS. The geriatric literature strongly suggests that frailty is associated with worse sleep outcomes in community-dwelling older adults, but this association has yet to be explored among pwMS. This study focused on examining the association between frailty and sleep quality in pwMS.

METHODS

Seventy-six people with both MS and obesity (mean age: 47.6 ± 10.9 years, 81.6 % female, mean body mass index (BMI): 37.10 ± 5.5 kg/m2, mean Patient Determined Disease Steps (PDDS): 0.82 ± 1.20) were included in this cross-sectional secondary analysis. A comprehensive frailty index (FI) based on 41 health deficits from various health domains was calculated based on standardized procedures. Sleep quality was determined by the Pittsburgh Sleep Quality Index questionnaire (PSQI).

RESULTS

Overall, 67.1 % of the participants were identified as non-frail (FI ≤ 0.25), and 32.9 % were identified as frail (FI > 0.25). A significant correlation was observed between FI scores and global PSQI scores (ρ = 0.43, p < 0.05). Cross-tabulation analyses revealed that frail participants had worse subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbances, daytime dysfunction, and higher use of sleep medications compared to non-frail participants (p < 0.05).

CONCLUSIONS

The current study identified a significant association between frailty and sleep quality in people with both MS and obesity with minimal disability. These findings underscore the importance of untangling the relationship between frailty and sleep quality in pwMS. These results could lead to a more targeted approach for rehabilitation interventions aiming to improve frailty in MS.

Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity

BACKGROUND

Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown.

OBJECTIVE

Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity.

METHODS

Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up.

RESULTS

Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008).

CONCLUSION

Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

A pilot study evaluating the prefeasibility of a behavioral weight loss program in people with multiple sclerosis

Weight loss interventions seldom include individuals with neurologic disease. The aims of the present study were to: 1) develop and assess the prefeasibility of a 6-month telehealth behavioral weight loss program for people with multiple sclerosis (MS) and obesity and 2) examine changes in weight loss (primary outcome), physical activity, and fruit/vegetable consumption at follow-up. Participants with obesity and MS engaged in a 24-week weight loss program. Participants followed established diet, exercise, and self-monitoring guidelines and attended weekly online group meetings. Median percentage weight loss was 10.54 % (SD = 7.19). Participants who adhered more closely to the self-monitoring guidelines (r = 0.81, p =.02), and who averaged higher weekly active minutes (r = 0.91, p =.002) achieved greater percentage weight loss. Six of the eight pilot participants achieved clinically meaningful weight loss (>5%) after 6-months.

Body metrics are associated with clinical, free-living, and self-report measures of mobility in a cohort of adults with obesity and multiple sclerosis

BACKGROUND

Obesity is associated with multiple sclerosis (MS) onset and may contribute to more rapid disability accumulation. Whether obesity impacts mobility in MS is uncertain. Some studies find that obesity in MS is associated with poorer mobility; other studies find no relationship. Discrepant findings may be due to differences in measurement and methodology. In the present study, we employ a comprehensive battery of anthropometric and mobility measures in a sample of people with MS and obesity.

METHODS

Participants with MS (N = 74) completed a battery of adiposity measurements (weight, height, waist circumference, and full body dual-energy x-ray absorptiometry [DXA] scans). They also completed validated clinical, free-living (accelerometry), and self-report measures of mobility. Spearman's Rho correlations were used to examine the associations between mobility and obesity measures with Benjamini and Hochberg correction for multiple comparisons. Multiple linear regression was used to examine if adiposity predicted mobility outcomes in people with MS when controlling for age and disease duration.

RESULTS

The majority of participants (n = 70) were diagnosed with relapsing-remitting MS and reported mild MS-related disability on the Patient Determined Disease Steps (M = 0.77, SD = 1.1). Median BMI was 35.8 (SD = 5.4). Higher percentage body fat (measured via DXA) was associated with poorer self-reported physical functioning (rs = -0.52, p <0.001), less moderate-to-vigorous physical activity (rs = -0.24, p = 0.04), and worse performance on the Six Minute Walk Test (6MWT; rs = -0.44, p <0.001), the Timed 25 Foot Walk (T25FW; rs = 0.45, p <0.001), and the Timed Up and Go test (TUG; rs = 0.35, p = .003). Higher BMI and waist-to-height ratio (WtHR) were associated with worse outcomes on the 6MWT (BMI; rs = -0.35, p <0.01, WtHR; rs = -0.43, p <0.001), T25FW (BMI; rs = 0.32, p <0.01, WtHR; rs = 0.38, p <0.001), and the SF-36 (BMI; rs = -0.29, p <0.005, WtHR; rs = -0.31, p <0.05). Percentage body fat accounted for an additional 17 % of the variance in the T25FW and 6MWT performance, after controlling for age and disease duration.

CONCLUSION

Higher BMI, WtHR, and percentage body fat were associated with lower levels of mobility (T25FW and 6MWT) in people with MS who have class I, class II, and class III obesity. Higher percentage body fat was associated with significantly worse performance on clinical, free-living, and self-report measures of mobility in people with MS even when accounting for participant age and disease duration. These findings suggest that people with MS and obesity may show improved mobility with weight loss.

Electronic Monitoring of Mom's Schedule (eMOMSTM): A Qualitative Study of Experiences in a Lifestyle Change Program with Lactation Support

PURPOSE

To elicit feedback from participants who completed the eMOMSTM study, a feasibility randomized controlled trial (NCT04021602), on their perceptions of program strengths and weaknesses.

STUDY DESIGN

Qualitative - Semi-structured, telephone interview guide using open-ended questions.

SETTING

Rural Great Plains state, United States.

PARTICIPANTS

Of 26 individuals who completed the eMOMSTM study, 24 consented to an interview.

METHOD

Interviews were completed between October 2020 and May 2021. Audio-recordings were transcribed verbatim and organized in Microsoft 365. Data were analyzed using an exploratory, inductive thematic analysis.

RESULTS

Participants' mean age was 27.5 (± 5.4) years and mean pre-pregnancy BMI was 29.5 kg/m2 (± 2.7). The majority (71%) were non-Hispanic White and 54% had a high school education/some college. Based on specific areas of inquiry, the following themes emerged: convenience of online program access using Facebook, importance of health coach's support and online interaction, positivity toward improving one's health, increased consciousness of health behaviors, diverse lactation educational needs, importance of educational materials on depression, and grief over the loss of birth expectations during COVID-19.

CONCLUSION

Findings suggest participants' perceived value of a lifestyle change program coupled with lactation education and support delivered using social media. Findings inform future studies to further adapt lifestyle change programs.

Electronic Monitoring Of Mom's Schedule (eMOMSTM): Recruitment of pregnant populations with elevated BMI in a feasibility randomized controlled trial

Underrepresentation of pregnant populations in randomized controlled trials of lifestyle change interventions is concerning due to high attrition and providers' limited clinical time. The purpose of this evaluative study was to assess intervention uptake of pregnant individuals enrolled in a three-arm feasibility randomized controlled trial, electronic Monitoring Of Mom's Schedule (eMOMS^TM), examining lifestyle changes and lactation support alone, and in combination. Measures included: (1) participation and completion rates, and characteristics of intervention completers versus other eligible participants; and (2) provider experiences with screening and enrolling pregnant participants. Pregnant people with a pre-pregnancy body mass index ≥ 25 and < 35 kg/m² were enrolled into the eMOMS^TM trial between September 2019 - December 2020. Of the 44 consented participants, 35 were randomized, at a participation rate of 35%, and 26 completed the intervention, resulting in a completion rate of 74%. Intervention completers were slightly older and entered the study earlier in pregnancy compared to non-completers. Completers were more likely to be first-time mothers, resided in urban areas, had higher educational attainment, and were slightly more racially and ethnically diverse. A majority of providers reported willingness to participate, believed the study aligned with their organization's mission, and were satisfied with using iPads for screening. Lessons learned to guide recruitment success include use of: (1) designated research staff in combination with physician support; and (2) user-friendly technology to help mitigate time burden on physicians and their staff. Future work should focus on successful strategies to recruit/retain pregnant populations in clinical trials.

Rural engagement in primary care for optimizing weight reduction (REPOWER): A mixed methods study of patient perceptions

OBJECTIVE

To report on patients' satisfaction and experience of care across three different modes of weight loss counseling.

METHODS

1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses.

RESULTS

1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight.

CONCLUSION

Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment.

PRACTICE IMPLICATIONS

Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.

The effect of nonpharmaceutical weight-loss interventions in rural patients with diabetes: RE-POWER Diabetes

OBJECTIVE

In this secondary analysis of the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) randomized trial, the authors determined the effectiveness of weight-loss interventions in people with diabetes compared with those without diabetes living in rural areas.

METHODS

The RE-POWER study was a randomized trial designed to determine the effectiveness of nonpharmacological behavioral weight-loss interventions in rural participants with obesity, comparing the individual in-clinic visit model to in-person group sessions and phone group sessions over 24 months. In this secondary analysis, weight loss was compared in participants with and without diabetes. The effects of factors such as medications, insulin, and behavioral factors were compared.

RESULTS

Participants with diabetes were less likely to lose weight during the study compared with those without diabetes up to 18 months (4.12% vs. 5.31%; net difference = 1.46%; 95% CI: 0.63%-2.28%). Participants with diabetes on insulin lost less weight than patients with diabetes not on insulin at 6 months (4.52% vs. 6.88%; net difference = 2.35%; 95% CI: 0.55%-4.16%). The group with diabetes had significantly lower changes in blood pressure and lipid parameters versus the group without diabetes.

CONCLUSIONS

Patients with diabetes in rural areas were less likely to lose weight, and metabolic parameters were less responsive to weight loss, compared with patients without diabetes.

OUP accepted manuscript

Rural populations continue to experience persistent cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination. Although the National Cancer Institute and the larger cancer research community have identified rural community partnerships as the foundation for reducing the disparities, we have identified limited application of community-based participatory research in cancer prevention and control research. Guided by the Community-Based Participatory Research Conceptual Model and our collective experience, we provide a framework for a community–cancer center partnership that focuses on promoting health equity. In this commentary, we articulate that the partnership process must foster capacity for communities and cancer centers, strive for rural representation in clinical trials and biobanking, build a pipeline for dissemination and implementation research, and create a bidirectional flow of knowledge between communities and academic institutions. Authentic partnerships with rural communities should be the ultimate goal of cancer centers, and the process described in this commentary can serve as an initial platform to build capacity and continue to strive toward that goal.

Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study

Objective

To describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO).

Design

This study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation.

Setting

The study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States.

Participants

Providers, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators.

Results

With integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process.

Conclusions

Joining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow.

Modifying Diet and Exercise in MS (MoDEMS): Study design and protocol for a telehealth weight loss intervention for adults with obesity & Multiple Sclerosis

Weight loss improves overall health, and reduces inflammation, risk of stroke, heart attack, diabetes, certain cancers, and death among individuals with obesity. Weight loss also improves mobility, increases stamina, and elevates mood. Between 25 and 33% of people with Multiple Sclerosis (pwMS) have obesity. Multiple Sclerosis (MS) and obesity are independently associated with reduced mobility, increased fatigue, and depression. Most behavioral weight loss trials exclude individuals with neurologic disease. Consequently, few studies have examined the effects of weight loss on symptom presentation and health outcomes among pwMS and obesity. This is the first study examining the efficacy of a comprehensive behavioral weight loss intervention designed specifically for pwMS. The purpose of this study is to develop and assess the efficacy of a telehealth administered weight loss intervention tailored for pwMS. Additionally, we aim to determine if weight loss reduces physical and emotional symptoms in individuals with obesity and MS. We will enroll 70 pwMS in a wait-list crossover trial to examine the efficacy of our intervention. If successful, findings will help determine whether we can help participants lose clinically significant weight - and whether weight loss among pwMS and overweight/obesity reduces fatigue, and improves mobility, mood, and quality of life.

Abstract PS7-44: Energetics and lifestyle in inherited syndromes (ELLIE'S study)

Background: US women have a 1 in 8 lifetime chance of developing breast cancer (BC), with an estimated 10% resulting from a hereditary BC gene mutation. Individuals with mutations in genes such as BRCA1 and BRCA2 have an increased risk of breast and ovarian cancer, as well as other types of cancers. At present, there are more than a dozen other hereditary cancer related genetic mutations that have an associated moderate to high risk of developing cancer. Along with an ability to identify and characterize risk in individuals with a hereditary cancer mutation, there is a need to study modifiable factors such as dietary intake and physical activity in relation to an individual’s risk for cancer.

Obesity and poor physical fitness are independently associated with an increased risk of BC and recurrence. There is a paucity of data on the impact of BMI, obesity, and physical activity on primary and recurrent BC in genetic mutation carriers. Women with a moderate penetrance gene mutation are at a high risk for BC and yet are likely to have an impact from modifiable risk factors. The impact of obesity, diet, and physical activity on BC risk and outcomes needs to be further characterized in genetic mutation carriers.

Methods: A short REDCap electronic survey was disseminated on social media and through our advocate partner Facing our Risk of Cancer Empowered (FORCE). Eligible participants include males or females, ≥18 years with a hereditary cancer genetic mutation. The survey includes questions regarding personal health, weight, height, metabolic risk factors, reproductive history as well as personal and/or family history of cancer and gene mutation status. In addition, includes a standardized assessment for diet (14-Item Mediterranean Diet Tool) and physical activity (IPAQ and modifiable PAQ). The first 1000 participants are compensated for their time with a $10 e-card. The survey is available in English and Spanish. The Spanish version was developed in collaboration with JUNTOS Kansas City.

Objectives: To establish a cohort and describe obesity rates, physical activity, metabolic factors, and nutrition in a cohort of individuals that have an increased risk of cancer due to a hereditary cancer genetic mutation.

Results: A total of N = 1,117 surveys have been completed as of June 30, 2020. Of them, 61.2% were removed from final analysis due to incomplete surveys, internet bots, and multiple single-user entries. A total N = 443 surveys have been verified and included in this analysis. Demographics: 98.6% female (n= 437), 94.4% white (n = 418) and median age 46 (range 19 – 77 yrs). Mutations represented in the cohort include: BRCA2 (39.0%), BRCA1 (29.1%), CHEK2 (13.1%), and ATM (5.9%) and &lt; 5%: PALB2, RAD51D, and TP53. Median BMI 24.9 ± 6.06 stdv. BMI 25 to &lt; 30: 26.4% (n = 117). BMI 30 or &gt; 30: 23.47% (n = 104). 61.3% responders are currently trying to lose weight. Attempts at weight loss: No attempts: n = 60 (13.5%), at least 1: n = 55 (12.4%), 2-5: n = 211 (47.6%), 6 or more: n = 117 (26.4%). Limitations to exercise include motivation (26.9%), time (23.5%), not liking exercise (15.6%), and lack of gym memberships (12.4%). 74.9% (n = 332) responded that they are interested in participating in future studies. The Spanish survey was made available 3/3/2020, no responses to date.

Conclusion: Individuals harboring a hereditary cancer genetic mutation are interested and willing to participate in research focused on lifestyle modifications and association with cancer risk. Rates of being overweight or obese are high and many have made multiple attempts at weight loss and find common barriers to exercise. Social media is a feasible platform to recruit to a lifestyle research project in a rare population. Additional steps to limit internet trolls, bots, and repetitive responses are necessary but did not impede recruitment. Further effort and collaboration are needed to expand the survey to underrepresented minorities.

Citation Format: Lauren E Nye, Kendra Cruz, Sue Friedman, Diane Rose, Christie Befort, Debra K Sullivan, Jill M Hamilton-Reeves, Lisa M Harlan-Williams, Fariba Behbod, Jo Wick, Melinda Irwin, Jennifer Klemp. Energetics and lifestyle in inherited syndromes (ELLIE'S study) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-44.

What I Wish My Doctor Really Knew: The Voices of Patients With Obesity

Few health care professionals receive comprehensive training in how to effectively help their patients with obesity. Yet patients are often wanting, needing, and looking for help when they go to the doctor. We, as a group of patients with obesity, share our common experiences and needs when going to the doctor from a place of honesty and hope, with the assumption that clinicians want to know what their patients really think and feel. Our "wish list" for a treatment plan may represent an ideal, but our hope is that our language will speak to clinicians about how they can help their patients manage their obesity.

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

PURPOSE

To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings.

DESIGN

Scoping review of the literature.

METHODS

The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies.

FINDINGS

Four steps to ACP were specified: identification, conversation, documentation, and follow-up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow-up, providers expressed a desire for electronic reminders as a behavioral regulator to follow-up.

CONCLUSIONS

While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight-knit community might be important facilitators of ACP in rural primary care.

CLINICAL RELEVANCE

Findings from this study can be used to accelerate ACP implementation in rural primary care.

Technology Components as Adjuncts to Family-Based Pediatric Obesity Treatment in Low-Income Minority Youth

BACKGROUND

Strategies to treat pediatric obesity are needed, especially among high-need populations. Technology is an innovative approach; however, data on technology as adjuncts to in-person treatment programs are limited.

METHODS

A total of 64 children [body mass index (BMI) ≥85th percentile, mean age = 9.6 ± 3.1 years, 32.8% female, 84.4% Hispanic] were recruited to participate in one of three cohorts of a family-based behavioral group (FBBG) treatment program: FBBG only, TECH1, and TECH2. Rolling, nonrandomized recruitment was used to enroll participants into three cohorts from May 2014 to February 2015. FBBG began in May 2014 and received the standard, in-person 12-week treatment only (n = 21); TECH1 began in September 2014 and received FBBG plus a digital tablet equipped with a fitness app (FITNET) (n = 20); TECH2 began in February 2015 and received FBBG and FITNET, plus five individually tailored TeleMed health-coaching sessions delivered via Skype (n = 23). Child BMI z-score (BMI-z) was assessed at baseline and postintervention. Secondary aims examined weekly FBBG attendance, feasibility/acceptability of FITNET and Skype, and the effect of technology engagement on BMI-z.

RESULTS

FBBG and TECH1 participants did not show significant reductions in BMI-z postintervention [FBBG: β = -0.05(0.04), p = 0.25; TECH1: β = -0.006(0.06), p = 0.92], but TECH2 participants did [β = -0.09(0.02), p < 0.001] and TeleMed session participation was significantly associated with BMI-z reduction [β = -0.04(0.01), p = 0.01]. FITNET use and FBBG attendance were not associated with BMI-z in any cohort. Overall, participants rated the technology as highly acceptable.

CONCLUSIONS

Technology adjuncts are feasible, used by hard-to-reach participants, and show promise for improving child weight status in obesity treatment programs.

Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention

Background

Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake.

Objective

To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors.

Methods

Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study.

Results

Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799).

Conclusions

Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals.

Trial Registration

Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9)

Measuring Nutrition Literacy in Breast Cancer Patients: Development of a Novel Instrument

No nutrition literacy instruments have been tested in breast cancer survivors, yet nutrition is a critical lifestyle factor for optimizing weight and improving quality of life in breast cancer survival. Our objectives were to adapt our Nutrition Literacy Assessment Instrument for breast cancer populations and to pilot test its validity and reliability. We modified the instrument based on review by content experts in cancer and nutrition and cognitive interviews with 18 cancer survivors. The modified instrument (Nutrition Literacy Assessment Instrument for Breast Cancer, NLit-BCa) was pilot-tested with 17 high-risk women and 55 breast cancer survivors. We conducted the NLit-BCa on two separate occasions 4 weeks apart and assessed reliability by confirmatory factor analysis. Construct validity was evaluated by comparing results of the NLit-BCa to a Healthy Eating Index score derived from two separate 24-h dietary recalls. Content validity of the NLit-BCa was acceptable (0.93). Entire reliability for three instrument domains was substantial (>0.80), while remaining domains demonstrated fair or moderate reliability. Significant relationships were found between five of the six domains of nutrition literacy and diet quality (P < 0.05). The NLit-BCa is content valid and demonstrates promising reliability and construct validity related to diet quality, through a larger sample size, and removal of non-discriminating items is needed to confirm these findings. Thus, the NLit-BCa demonstrates potential for comprehensively measuring nutrition literacy in breast cancer populations.

Career Goals and Retention-Related Factors Among College Freshmen

The relationships of four types of career goals (job related, school related, value related, and unknown) with factors of school retention, academic performance, self-esteem, educational self-efficacy, and school and career commitment are studied among 401 first-semester college freshmen. Differences in types of goals based on gender are also considered. Students reporting job-related goals are more likely to make positive persistence decisions than students reporting unknown goals. Men are more likely to report value-related goals than women, whereas women are more likely to report job-related goals than men. Implications of these findings for those working in college settings that help foster students’ career development and academic success are discussed.

Weight Management to Reduce Prostate Cancer Risk: A Survey of Men's Needs and Interests

Obese men have a higher rate of prostate cancer-related death than non-obese men, and obesity increases the risk of prostate cancer progression and biochemical recurrence. The purpose of this study was to assess needs and interests of men for a technology-driven weight loss intervention to reduce prostate cancer risk. We distributed a survey collecting demographic characteristics, health history, exercise and eating habits (and perception of those habits), current and prior attempts of health behavior change, and technology use. Survey answers were summarized by count and percent of total respondents. Completed surveys (N = 109) described men with a family history of prostate cancer (25%), a history of elevated prostate specific antigen (26%), and prostate cancer survivors (22%). We compared body mass index (BMI) to perception of weight; overweight and obese men perceived their weight as more normal than their BMI category suggests. Most men reported their diet needed minor improvement (74%), and 65% of men reported they are either currently trying to lose weight or interested in weight loss. Most respondents access the internet (92%), while text messaging (60%) and smartphone application use (40%) are less frequent, especially in men over 60. Our results revealed a need and willingness for lifestyle modification and suggest a need for evidence-based weight loss strategies and for addressing the misperception of weight status. A male-tailored intervention that implements technology could improve energy balance, hold men accountable to healthy behavior change, and promote dietary patterns in order to reduce prostate cancer risk.

Identifying Awareness, Use, and Perceptions of text4baby among Family Medicine and Obstetrics and Gynecology Practitioners at the University of Kansas Medical Center

Background. Low income minority women who receive inadequate or no prenatal care have greater infant morbidity and mortality in the postnatal period. Mobile health or mHealth initiatives such as text4baby are presumed to be a means to reach underserved pregnant and postpartum women to increase their use of prenatal and postnatal care. Providers are an important referral source for mHealth initiatives. It is important, therefore, to assess the awareness, use, and perceptions of the text4baby program among Family Medicine and Obstetrics/Gynecology (Ob/Gyn) providers to determine the means to increase referrals and improve outcomes for pregnant mothers and infants. Methods. Family medicine and Ob/Gyn providers (attending physicians, residents, nurse practitioners, nurses, and medical assistants) at the University of Kansas Medical Center (KUMC) completed a survey assessing awareness of use and perceived utility of text4baby as well as experience with technology and reservations about mHealth in general. Results. Seventy-eight providers (38 in Family Medicine and 40 in Ob/Gyn) responded to the survey. Awareness of text4baby among all providers was 18%. Among the 14 providers who knew about text4baby, one individual stated he/she regularly refers patients to text4baby and 11 agreed that text4baby is a useful tool for the care of pregnant patients. Comparison of text4baby awareness by demographic factors showed no significant differences between any of the groups. Providers who knew of mHealth applications were more likely to know about text4baby (p = 0.04). Older providers were less likely to have reservations about using mHealth in their practice (p = 0.02). There was widespread agreement (87%) that providing evidence to clinicians that text4baby improves outcomes would increase use of the service in clinical practice. Conclusions. Awareness of text4baby among practitioners at KUMC is minimal; use is negligible. Our study identified lack of awareness of the text4baby service and of supporting evidence about its effectiveness as the primary barriers to referral.

iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention

BACKGROUND

Pediatric obesity is a serious and prevalent problem. Smartphone technology, which is becoming increasingly available to children of diverse backgrounds, presents a unique opportunity to instill healthy behaviors before the onset of obesity. Past studies have examined the use of smartphone applications as tools of health behavior modification for adults. The present study examines the content of children's exercise and nutrition smartphone apps.

METHOD

Sixty-two iPhone apps were identified and coded by two independent raters for adherence to expert-recommended behaviors (e.g., five fruits/vegetables per day) and strategies (e.g., self-monitoring diet/physical activity) for the prevention of pediatric obesity.

RESULTS

App behavioral and strategy index scores were uniformly low. Apps were more likely to address expert-recommended behaviors for the prevention of pediatric obesity (93.5%), whereas few apps addressed recommended strategies (20.9%). The most common behaviors addressed included physical activity (53.2%) and fruit/vegetable consumption (48.3%). Other important behaviors (e.g., screen time [1.6%] and family meals together [1.6%]) were rarely addressed.

CONCLUSIONS

Current children's diet and exercise apps could be improved with increased adherence to expert-recommended guidelines, especially expert-recommended strategies.

The nutrition needs of low-income families regarding living healthier lifestyles: Findings from a qualitative study

Pediatric obesity and nutrition-related problems continue to be problematic around the world. The purpose of the current qualitative study was to learn more about the barriers low-income, minority families face to healthy living and where they turn for health-related information. Five focus groups were conducted using open-ended standardized questions. Standardized transcript analysis and coding techniques were used to arrive at five saturated themes. The project was conducted in partnership with a community based Early/Head Start agency. Adult parents of preschool children were invited to participate. Results indicate that low-income minority families face many barriers to eating healthily: while families do eat some healthy foods, they also eat many unhealthy foods; they rely primarily on family members for their nutrition information; they have some desire to change their own health habits (but generally not those of their children); and they have inadequate nutritional knowledge. Options for better reaching this population with important health information are discussed.

Obesity and related health behaviors among urban and rural children in the United States: data from the National Health And Nutrition Examination Survey 2003-2004 and 2005-2006

OBJECTIVE

To assess rates of overweight/obesity and related health behaviors among rural and urban children using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Data were drawn from the 2003-2004 and 2005-2006 NHANES surveys regarding demographic characteristics, weight status, dietary behaviors and physical activity behaviors.

RESULTS

Significantly more rural children were found to be obese than urban children. Health behavior differences to explain this differential obesity rate were primarily not significant, but multivariate analyses indicate that for rural children meeting physical activity recommendations is protective and engaging in more than 2 hr/day of electronic entertainment promotes obesity.

CONCLUSIONS

There are modifiable health behavior differences between rural and urban children which may account for the significantly higher obesity rates among rural children.

Abstract B4: Impact of obesity on the effectiveness of aromatase inhibitors (AIs): Can breast cancer survivors on AIs lose weight compared to non-AI users?

Background and Objectives: Weight at diagnosis and weight gain after diagnosis are associated with increased risk of breast cancer (BrCa) recurrence and mortality. In addition, post-menopausal obese breast cancer survivors on anti-hormonal therapy were 40% more likely to develop a local recurrence and 46% more likely to develop a distant recurrence compared to their normal weight counterparts. This evaluation was conducted to examine if a diet/exercise/behavioral weight loss intervention for overweight breast cancer survivors: 1) would impact BrCa risk biomarkers and 2) would the response differ by aromatase inhibitor (AI) status.

Methods: 84 BrCa survivors with a BMI 25-45 kg/m,2 ≥3 months from chemotherapy were recruited, and 52 agreed to participate. 6 (11%) participants did not complete the intervention. The 6-month intervention included: 225 minutes/week of aerobic exercise, resistance training, 1200-1500 calorie/day diet, and weekly group behavioral meetings. Pre and postintervention assessments included: anthropometrics (weight, BMI), body composition (DEXA % body fat), and serum biomarkers (estradiol, testosterone, SHBG, IGF-1/IGFBP3, insulin, leptin, adiponectin, glucose, CRP, cholesterol). Results are shown for 52 women (median age 52 ± 8 years) who initiated the program and 45 (87%) who completed the 6-month intervention.

Results: Women were approximately 4.25 years from diagnosis, their median weight at diagnosis was 84.1 kg (±15.8), and BMI was 31.3 kg/m2 (±5.6). Median pre-intervention weight was 91.8 kg (±13.4) and participants lost an average of 10.6 kg (±6.0)* or 13.3% (±28.8)* of their starting weight after the 6-month intervention. BMI decreased from 32.6 kg/m2 (±4.7) to 28.2 kg/m2 (±4.7)* and total percent body fat decreased by 5.6% (±4.5)*. Favorable changes in serum biomarkers of BrCa risk were observed for insulin*, leptin*, adiponectin*, and estradiol*. When comparing AI users to nonusers the significant favorable change in estradiol was not seen for those on AI's. There was a significant difference in decrease in % body fat* between AI users and nonusers. No other differences were significant. (*p-values &lt;0.05)

Conclusions: Overall, results suggest a 6-month diet/exercise/behavioral weight loss intervention in overweight post-menopausal BrCa survivors results in a significant decrease in weight and change in serum biomarkers of BrCa risk in both current AI users and nonusers, however, due to the small sample size significant between group difference were not seen. Larger studies evaluating the effects of weight and weight loss based on exposure to antihormonal therapy are needed.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):B4.

Prevalence and predictors of tobacco treatment in an academic medical center

BACKGROUND

Hospitalized smokers are a large and important but undertreated population. Although effective strategies have been developed to enhance smoking cessation, many hospitalized smokers still fail to benefit from these services. A study was conducted to examine the reach of services within a hospital tobacco treatment program and to identify predictors of referral and treatment.

METHODS

Electronic medical records were downloaded for all 3,600 smokers admitted to a 475-bed academic medical center hospital in a one-year period.

RESULTS

More than one in four of identified smokers were referred to the specialty service and nearly one in five received treatment. Logistic regression models found that Joint Commission core measure status (heart failure, myocardial infarction, and pneumonia) was the strongest predictor of referral, followed by a history of smoking for more than 10 years. Conversely, smokers admitted for emergency medical services were less likely to be referred compared with those admitted electively. Patients treated on surgical, obstetric, and psychiatric services were less likely to be referred for tobacco treatment than those treated on medical services. Of those referred, smokers with longer lengths of stay and those admitted through the emergency department were more likely to actually receive services.

DISCUSSION

To capitalize on hospitalization as a "teachable moment," other subpopulations, such as psychiatric and obstetric patients, deserve attention. Tobacco treatment services must be fully integrated into hospital systems, configured to deliver care to all smokers, and reimbursed to ensure sustainability. This study's identification of underserved groups, determination of potential roadblocks to delivery of services, and suggestion of ways to disseminate treatment equitably to all smokers should prove helpful to policymakers.

Feasibility of a 6-Month Diet, Exercise, and Behavior Modification Intervention for Post-Menopausal Breast Cancer Survivors

Background: Obesity is prevalent in general population and among breast cancer (BrCa) survivors. Weight at diagnosis and weight gain after diagnosis are associated with increased risk of breast cancer recurrence and mortality. Regular exercise similarly reduces the risk of dying from breast cancer. This study was conducted to determine the feasibility of a structured diet/exercise/behavioral intervention program with a goal to achieve a weight loss of 5% or more, and to study the effect of participation in the program on serum biomarkers of breast cancer risk, measures of overall health, strength, and fitness level..Methods: Subjects in this prospective pilot study are female, overweight BrCa survivors with a BMI &gt;25, and who were at least 3 months out of adjuvant chemotherapy. The 6-month combined modality diet/exercise/behavior modification intervention included: 225 minutes per week of cardiovascular exercise in addition to resistance training, a 1200-1500 calorie/day diet including participant purchased pre-packaged meals and low calorie shakes, and a weekly in-person group behavioral meeting. Women were recruited into groups of 10 to15 participants (total n=50), with a planned goal of 4 cohorts, and anticipated complete data collection by December 2009. Participants underwent pre and post intervention assessments including: anthropometric measures, serum biomarkers, fitness test, and questionnaires to assess food frequency, fatigue, and quality of life. Changes over time were assessed using Wilcoxon signed rank test. We present here the data on first 12 women who have completed the 6 month intervention, out of a planned accrual of 50.Results: Since November 2008, 55 women were screened and 38 women agreed to participate in the 6-month intervention (13 in cohort 1; 10 in cohort 2; 15 in cohort 3). Only 1 participant dropped out of cohort 1 due to a non-study related injury. Major reasons for not participating included: already started another weight loss program, timing, and lack of availability for the evening meeting. Mean age of the participants was 50.7 (range 40-57) and mean time from diagnosis to the time of enrollment was 45 months (range 20-132). Eight five percent of the participants received adjuvant or neo-adjuvant chemotherapy and 77% were either currently or had previously taken anti-hormonal therapy.Median weight was 230 lbs (range 165-268) at baseline .and 198 lbs (range 139.6-243.8) at 6 month (median weight loss: 32 lbs or 14%; p=0.00); median BMI was 36.4kg/m2 (range 30.3-45.4) at baseline and 31.54kg/m2 (range 26.4-40.7) at 6-months (p=0.00), median percent body fat by DEXA scan was 50.9 (range 45-58.4) at baseline and 46.3 (range 35.6-55.4) at 6-months (p=0.00). Participants increased their metabolic equivalent task hours per week (MET/HRS) of exercise from 6.6 (range 0-25) at baseline to 20.4 (range11.8-40.5) at 6-months (p=0.01).Conclusion: A 6-month diet/exercise/behavior modification intervention program is feasible and results in a significant decrease in overall weight and percent body fat among overweight breast cancer survivors.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1058.

Support needs of overweight African American women for weight loss

OBJECTIVES

To examine social support needs of obese and overweight African American women for weight loss.

METHODS

Focus groups were conducted with overweight and obese African American women. Data were analyzed using standard grounded theory text analysis.

RESULTS

Our middle-aged (45.7 years; SD = 12.6) women (N = 66) were interested in receiving support from others focused on the health benefits of weight loss. Behaviors perceived as supportive include co-participating in exercise, providing nutrition education, using positive reinforcements, and avoiding criticism.

CONCLUSIONS

African American women are interested in a program designed to increase social support for their weight loss.

Competitive foods in schools: availability and purchasing in predominately rural small and large high schools

OBJECTIVES

Schools have an important role to play in obesity prevention, but little is known about the food environment in small, predominately rural schools. The primary purpose of this study was to compare the availability and student purchasing of foods sold outside of the reimbursable meals program through à la carte or vending (ie, competitive foods) in small (n=7) and large (n=6) Kansas high schools.

METHODS

A cross-sectional observational study design was used to capture the number of à la carte and vending items available and purchased, and the fat and energy content of all available and purchased items on a single school day between January and May 2005.

RESULTS

Small schools had significantly fewer vending machines than large schools (median 3.0 [range 2.0 to 5.0] vs 6.5 [range 4.0 to 8.0], P<0.01]. Vending and à la carte items at small schools contained a median of 2.3 fewer fat grams per item (P< or =0.05), whereas vending products contained a median of 25 kcal fewer per item (P< or =0.05) than at large schools. Significantly less fat (median -15.4 g/student) and less energy (median -306.8 kcal/student) were purchased per student from all competitive food sources and from à la carte (median -12.9 g fat and -323.3 kcal/student) by students in small schools compared to students in large schools (P< or =0.05).

CONCLUSIONS

The findings, which highlight less availability and lower energy content from competitive foods at small compared to large schools, have implications for understanding how small schools support their foodservice programs with limited dependence on competitive foods and the influence that food and nutrition professionals can have on school environments by providing more oversight into the nutritional quality of foods available.

A qualitative assessment of weight control among rural Kansas women

OBJECTIVE

To explore weight control beliefs, attitudes, knowledge, and practices among rural Kansas women, and to characterize the relationship of these women with their primary-care providers around weight control.

DESIGN

Qualitative research using focus groups.

SETTING

Three separate communities of rural Kansas.

PARTICIPANTS

Six focus groups among 31 women during fall 2006.

INTERVENTION

Two focus groups in each community, each of 2-hour duration. A focus group moderator's guide was used to explore the roles of individuals, primary-care practice teams, and communities around weight control.

ANALYSIS

This study used a qualitative analysis with an iterative process and standard techniques. The analysis team summarized central findings, descriptive topic areas, and general themes.

RESULTS

There were 5 broad themes that emerged from these focus groups. These themes are lack of support from primary-care providers; primary-care offices as community resources; lack of resources for promoting dietary change, but adequate resources for physical activity; the importance of group support and inclusiveness; and a need for more intensive interventions for weight control.

CONCLUSIONS AND IMPLICATIONS

Rural populations have an above-average prevalence of obesity and related comorbidities. Rural communities need better approaches for addressing the obesity epidemic.

Demographic and psychosocial factors associated with increased fruit and vegetable consumption among smokers in public housing enrolled in a randomized trial

OBJECTIVES

To examine the demographic and psychosocial factors associated with increased fruit and vegetable (FV) consumption among smokers residing in public housing.

DESIGN

Cluster randomized trial of 20 public housing developments (HDs). Ten housing developments were randomly assigned to a FV intervention and 10 to a smoking cessation intervention.

PRIMARY OUTCOME

Change in daily FV intake over the past 7 days at 8 weeks postbaseline.

RESULTS

Above the effect of treatment, baseline confidence for vegetable consumption (model coefficient = 0.19, SE = 0.07, p = .01), decreased barriers (model coefficient = -0.12, SE = 0.04, p = .002) and increased agency (model coefficient = 0.08, SE = 0.04, p = .03) were significantly associated with week 8 FV consumption.

CONCLUSIONS

Although the intervention produced significant change in FV consumption, the majority of individual psychosocial factors were not associated with this change. Future studies examining the dynamic interaction between interventions and individual, social, and environmental factors are needed to more fully explain dietary change among public housing residents.

Perceived barriers and benefits to research participation among school administrators

BACKGROUND

Gaining access to conduct research in schools can be challenging, but little has been done to directly assess school administrators' perceptions of research. The purpose of this qualitative study was to increase understanding of barriers and benefits of research participation as perceived by superintendents and principals in elementary, middle, and high school settings.

METHODS

Administrators (14 elementary, 14 middle, and 15 high school principals and 14 superintendents; total n = 57) were randomly selected from across a Midwestern state and were interviewed by phone following a semistructured guide of questions.

RESULTS

Six major themes were consistent across principals and superintendents and reached saturation. Themes indicated that administrators were interested in research projects that (1) provide tangible benefits to their school, (2) are consistent with their academic mission, (3) are not burdensome, (4) do not take place during state assessment time or other busy times, and (5) are credible and noncontroversial. Previous research experiences leave a lasting impression on administrators and influenced their future decisions.

CONCLUSIONS

Findings indicate that researchers should carefully frame their research in terms of how it will directly benefit the school, keeping in mind that academic performance is the top priority for school administrators. Researchers should be very clear and realistic about the time commitments, how the research results will be provided, and how the study may be used to improve the school's academic mission.

Smoking-related weight control expectancies among African American light smokers enrolled in a smoking cessation trial

Concern about weight gain following smoking cessation has been frequently described in the literature. However, little is known about smoking-related weight expectancies among African American, light smokers (defined as < or = 10 cigarettes per day [CPD] for > 25 of last 30 days). Given the high rate of obesity among African Americans, concern about weight gain may be a significant barrier to cessation. The association of demographic, psychosocial and tobacco-related variables and smoking-related weight control expectancies were examined in 755 African American regular, light smokers enrolled in a smoking cessation trial (number of years smoked=23.9+11.9; CPD=7.6+/-3.2; age=45.1+/-10.7; BMI=31+/-8.1; 67% female). Overall, participants had minimal smoking-related weight control expectancies (M=3.7/10, SD+/-3.4); however, higher weight control expectancies were related to female gender, lower dietary fat intake and lower internal self-efficacy to refrain from smoking. Further, smoking-related weight control expectancies were not associated with cessation outcome at week-26. Findings suggest that weight control expectancies exist among some African American light smokers and are related to decreased self-efficacy to refrain from smoking. However, the relationship between smoking-related weight expectancies and health behaviors are complex and modest in magnitude.

Kansas primary care weighs in: a pilot randomized trial of a chronic care model program for obesity in 3 rural Kansas primary care practices

CONTEXT

Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care.

PURPOSE

To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary care.

METHODS

We enrolled 107 participants to a 6-month, 2-armed, randomized trial comparing a CCM for obesity with usual care. The primary outcome was weight change at 90 days. The usual care arm received educational weight loss materials and outcome assessments at day 0, 90, and 180. The active arm received the same elements as the usual care arm plus a multicomponent obesity CCM.

FINDINGS

The Day 90 mean +/- SD weight change for the active arm (n = 34) and control arm (n = 33), respectively, was -4.5 +/- 7.7 pounds and -2.4 +/- 8.1 pounds (P = .27 for difference). The Day 180 mean +/- SD weight change for the active (n = 27) and control (n = 27) arms, respectively, was -9.4 +/- 10.3 pounds and -2.1 +/- 10.7 pounds (P = .01 for difference). There was no significant change in physical activity, or fruit and vegetable intake at day 90 or day 180.

CONCLUSIONS

Improving the recognition and treatment of obesity in primary care settings is a critical initiative. Rural populations suffer disproportionately with obesity, and better methods of delivering obesity care are needed for this population. Further research is needed to establish the effectiveness of a CCM approach for obesity care.

Fruit, Vegetable, and Fat Intake among Non-Hispanic Black and Non-Hispanic White Adolescents: Associations with Home Availability and Food Consumption Settings

OBJECTIVE

This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents.

PARTICIPANTS AND DESIGN

Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods.

MAIN OUTCOMES

Correlates of fruit, vegetable, and fat consumption.

STATISTICAL ANALYSIS

Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents.

RESULTS

In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake.

CONCLUSIONS

Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.