Psychological processes linking problematic smartphone use to sleep disturbance in young adults

OBJECTIVES

With such high rates of sleep and mental health problems among undergraduate students, understanding potential antecedents of these interrelated problems has emerged as a critical area of examination. One potential factor underlying these problems is problematic smartphone use, which is defined as excessive phone use, impulse control problems related to the use, and negative consequences stemming from these behaviors. Accordingly, the current study sought to examine how relative changes in problematic smartphone use might impact college students' sleep disturbance via their psychological functioning (ie, psychological inflexibility and anxiety symptoms).

METHODS

The 2-wave (baseline and 2-month follow-up) online sample consisted of 385 undergraduates (81% female; M = 20.0, SD = 1.6), who reported problematic smartphone use, psychological flexibility, anxiety symptoms, and sleep disturbance.

RESULTS

Controlling for baseline levels of sleep hygiene, age, and gender, our model demonstrated a significant indirect effect from problematic smartphone use to sleep disturbance. Specifically, relative increases from baseline to the 2-month follow-up in students' problematic smartphone use predicted subsequent increases in psychological inflexibility, which predicted increases in anxiety symptoms, which, in turn, predicted increases in sleep disturbance.

CONCLUSIONS

Given the ubiquity of college students' smartphone use, the potential for problematic use remains high. Results suggest that the negative consequences of problematic smartphone use not only can include college students' mental health but also their sleep. With such high levels of college students suffering from mental health and sleep problems, clinicians and college administrators should consider the potential sequelae of the problematic use of smartphones.

Dispositional mindfulness predicting psychological adjustment among college students: the role of rumination and gender

OBJECTIVE

This study examined rumination as a mediator of the relationship between dispositional mindfulness (DM) and depression, loneliness, and anxiety, while considering gender as a moderator of these mediation models.

PARTICIPANTS

Three hundred and nineteen undergraduate students (49.5% female; M = 18.90 years) participated with data collected from January 2018 to April 2019.

METHODS

Self-report measures of DM, rumination, symptoms of anxiety and depression, loneliness, and social support were completed.

RESULTS

Males scored significantly higher than females on DM, while females scored significantly higher than males on rumination and psychological distress. Rumination mediated the relationship between DM and all adjustment variables. The mediation model predicting depression was moderated by gender, showing stronger effects for females than males.

CONCLUSION

Results support rumination as a mechanism underlying the association between DM and psychological adjustment and suggest that targeting both DM and rumination could maximize the effectiveness of mindfulness-based interventions for college students' well-being.

The role of financial strain in college students' work hours, sleep, and mental health

To examine poor sleep quality as a potential mediator between college students' employment hours and depressive symptoms, and to examine if this mediation model might differ across students reporting different levels of financial strain. Participants: The sample was collected through a multi-site study during the Spring of 2019 and included 792 undergraduates (M = 20.1, SD = 1.9) in Upstate New York. Methods: Moderated mediation analyses based on cross-sectional self-report, online questionnaires. Results: Increased work hours predicted greater sleep disturbance, which, in turn, predicted more depressive symptoms. Compared to students in more comfortable financial situations, this mediation model only emerged for students reporting more financial strain and lower family socio-economic status. Conclusions: Student employment hours are a significant predictor of students' mental well-being when considering their potential impact on their sleep. Furthermore, students reporting higher levels of financial stress are most at risk of being impacted by this process.

Facets of dispositional mindfulness versus sources of social support predicting college students' psychological adjustment

Objective: This study examined the relative contribution of five dispositional mindfulness (DM) facets and two aspects of social support along with sex in predicting psychological adjustment. Participants: Three hundred fifty-three undergraduates (72% female; M = 18.82 years) participated with data collected from September 2014 through March 2016. Methods: Self-report measures of DM, social support, perceived stress, and emotional well-being were completed. Results: Sex and higher scores on specific mindfulness facets (ie, nonreactivity, nonjudging) predicted lower stress and greater emotional well-being. Higher family support predicted lower stress, whereas friend support predicted greater emotional well-being. The mindfulness facets were stronger predictors of adjustment than the social support domains. Females reported higher perceived stress and lower emotional well-being than males, and males scored significantly higher on total mindfulness, nonjudging, and nonreactivity. Conclusions: Results have implications for mindfulness-based interventions with college students such that focusing on the nonjudging and nonreactivity facets may enhance effectiveness.

Predictors of Gestational Weight Gain among White and Latina Women and Associations with Birth Weight

This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, p < 0.016). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8-6.5) and obese (OR = 4.5, CI = 2.3-9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8-8.8). GWG was positively associated with neonate birth size (p < 0.001). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed.

Predicting Medical Regimen Adherence: The Interactions of Health Locus of Control Beliefs

The present study examined the interactions between five dimensions of health locus of control beliefs and their relationships with medical regimen adherence in low-income individuals diagnosed with type 2 diabetes. One hundred and nine patients were administered an expanded Multidimensional Health Locus of Control (MHLC) scale. HbA1c was used as a biological indicator of medical regimen adherence. Multivariate regression analyses demonstrated that three interactions were significantly related to HbA1c. The present findings suggest that HLOC may be meaningfully related to medical outcomes. However, these relationships may not be captured through the examination of main effects and may be only found when interactions are considered.

Gender differences in freshmen weight gain

OBJECTIVE

Predictors of first semester and year weight change by gender were examined.

PARTICIPANTS

The participants were 304 freshmen recruited over three years (September 2010, 2011, & 2012).

METHODS

Psychosocial and lifestyle variables and weight were assessed at the beginning and end of the Fall semester and end of the Spring semester.

RESULTS

The average weight gain over the year was 6.38 lbs for males versus 4.38 lbs for females. In the first semester, alcohol use was associated with weight gain among males. For females, higher levels of physical activity and lower BMI were associated with weight gain. At the end of the year, happiness was negatively associated with weight gain among males and physical activity positively associated with weight gain in females.

CONCLUSIONS

Alcohol consumption in males and physical activity in females produced positive associations with weight gain with most of the weight gained during the first semester. This implies that efforts to prevent weight gain in college freshmen need to be tailored by gender and focus on first semester.

Vagus nerve stimulation and food intake: effect of body mass index

Animal research suggests that vagus nerve stimulation (VNS) is associated with weight loss and decreased appetite. Results from human studies are mixed; some suggest that VNS affects weight whereas others do not, and it is unclear how VNS affects eating behaviors. Baseline body mass index (BMI) and VNS device settings may moderate the effects of VNS on caloric intake. This study investigates the association among BMI, VNS device settings, and caloric intake of highly palatable foods during VNS on versus VNS off sessions in 16 adult patients (62.5% female; BMI mean = 29.11 ± 6.65) using VNS therapy for either epilepsy or depression. Participants attended 2 experimental sessions (VNS on versus off) where they were presented with 4 preferred snack foods totaling 1600 calories. At the start of the session, they either had their VNS devices turned off or left on. Caloric intake was calculated by weighing foods before and after each session. BMI category (overweight/obese and lean) was the between group factor in the analysis. After controlling for covariates, an interaction of condition and BMI category (P = .03) was found. There was an interaction of condition and device output current (P = .05) and a trend toward an interaction of condition and device on time (P = .07). Excess weight may impact how neurobiological signals from the vagus nerve affect appetite and eating. Future research is needed to further elucidate this relationship.

Mindfulness and alcohol problems in college students: the mediating effects of stress

OBJECTIVE

To examine the relationship between mindfulness and alcohol problems in college students, as well as the role of stress as a mediator in this relationship.

PARTICIPANTS

Participants were 310 students from a small, private college in the Northeast.

METHODS

Students completed self-report measures, including the Perceived Stress Scale, the Five Facet Mindfulness Questionnaire, and the Rutgers Alcohol Problems Index.

RESULTS

Mindfulness was negatively correlated with alcohol problems and stress, whereas stress positively correlated with alcohol problems. Results implicated stress as fully mediating the relationship between mindfulness and alcohol problems. Alcohol problems were negatively correlated with the Acting With Awareness and Describing Experience facets of mindfulness.

CONCLUSION

Mindfulness-based stress reduction or other mindfulness programs may be useful in decreasing alcohol problems on college campuses via the effects on stress.

Male inclusion in randomized controlled trials of lifestyle weight loss interventions

The prevalence of obesity is similar for men (32.2%) and women (35.5%). It has been assumed that lifestyle weight loss interventions have been developed and tested in predominately female samples, but this has not been systematically investigated. The aim of this review was to investigate total and ethnic male inclusion in randomized controlled trials of lifestyle interventions. PUBMED, MEDLINE, and PSYCHINFO were searched for randomized controlled trials of lifestyle weight loss interventions (N = 244 studies with a total of 95,207 participants) published in the last 10 years (1999-2009). A trial must be in English, included weight loss as an outcome, and tested a dietary, exercise, and/or other behavioral intervention for weight loss. Results revealed samples were on average 27% male vs. 73% female (P < 0.001). Trials recruiting a diseased sample included a larger proportion of males than those not targeting a disease (35% vs. 21%; P < 0.001). About 32% of trials used exclusively female samples, whereas only 5% used exclusively male samples (P < 0.001). No studies in the past 10 years specifically targeted minority males. Ethnic males identified composed 1.8% of total participants in US studies. Only 24% of studies that underrepresented males provided a reason. Males, especially ethnic males, are underrepresented in lifestyle weight loss trials.

Association of post-traumatic stress disorder and obesity in a nationally representative sample

Recent studies suggest a possible link between post-traumatic stress disorder (PTSD) and obesity risk, which would have implications for the development of obesity-related diseases in this population. The present study examined the association between PTSD and obesity and whether this association differed by sex in a representative sample of the US population. A secondary objective was to determine whether the association between PTSD and obesity was mediated by binge eating disorder (BED). Data were from the Collaborative Psychiatric Epidemiology Surveys (CPES), which comprises three nationally representative cross-sectional surveys that were conducted between 2001 and 2003. Logistic regression analyses weighted to represent the general US adult population were performed. In the total sample of 20,013 participants, rates of obesity were 24.1% for persons without a lifetime history of PTSD and 32.6% among persons with PTSD in the past year. Adjusting for socio-demographic characteristics, depression, substance and alcohol abuse/dependence, and psychotropic medication status, past year PTSD was associated with greater likelihood of obesity (odds ratio (OR) = 1.51; 95% confidence interval (CI) = 1.18, 1.95), with no differences by gender. BED did not statistically mediate the relationship between PTSD and obesity. The present study provides support for a link between PTSD and obesity. Findings further existing literature by indicating that the association is consistent across sexes and is not statistically mediated by BED.

Associations of mood and anxiety disorders with obesity: comparisons by ethnicity

OBJECTIVE

The aim of this study is to compare the associations of mood and anxiety disorders (12 months and past diagnosis) with obesity among ethnically diverse adults.

METHODS

Data from Caucasians, African American, and Latinos in the National Comorbidity Survey Replication (NCS-R), National Latino and Asian American Study (NLAAS), and National Study of American Life (NSAL) were analyzed (n=17,445). Multivariate logistic regression models tested the associations between 12 month and past diagnosis of mood and anxiety disorders with obesity (body mass index ≥ 30kg/m²).

RESULTS

Approximately 52% of the sample was female and 24% obese. Among Caucasians, 12-month mood disorder (OR=1.30, 95% CI=1.05, 1.62), past diagnosis of mood disorder (OR=1.37, 95% CI=1.11, 1.69) and 12-month anxiety disorder (OR=1.40, 95% CI=1.02, 1.68) were associated with greater likelihood of obesity. Among African Americans, past year anxiety disorder (OR=1.63, 95% CI=0.92, 1.67) was associated with greater likelihood of obesity, and a trend toward an association between 12 month mood disorder (OR=1.24, 95% CI=0.92, 1.67) and obesity was observed. Similarly among Latinos, past year anxiety disorder (OR=1.45, 95% CI=1.00, 1.99) was associated with greater likelihood of obesity, and a trend toward an association between 12-month mood disorder (OR=1.26, 95% CI=0.94, 2.01) was observed. Tests of statistical interaction to assess heterogeneity of the associations of mood and anxiety disorders with obesity, comparing African Americans and Latinos to Caucasians, suggest differences in the association of past diagnosis of mood disorder with obesity (P<.10 for both groups).

CONCLUSIONS

Results suggest similar associations between 12-month mood and anxiety disorders with obesity across groups.

Awareness of diabetes risk factors and prevention strategies among a sample of low-income Latinos with no known diagnosis of diabetes

PURPOSE

This study assessed awareness of type 2 diabetes risk and severity, perceived risk factors, knowledge of diabetes prevention strategies, and challenges of and opportunities for prevention among low-income Latinos in Lawrence, Massachusetts.

METHODS

Qualitative research design. Latinos with no known diagnosis of diabetes participated in 4 focus groups, conducted in Spanish, which were recorded and transcribed for systematic analysis.

RESULTS

The sample, (N = 41) was largely female (85%) with a wide age range (22-76 years), most (71%) had an educational level of high school or less, and less than half (46%) were employed. Participants had basic knowledge of diabetes, but gaps were apparent. Many perceived family history of diabetes, poor diet, emotional distress, and stress associated with the United States as risk factors for diabetes. There was little or no awareness of risk associated with Latino ethnicity, gestational diabetes, hypertension, lipid abnormalities, or obesity. Few cited physical activity or weight loss as diabetes prevention strategies. More than half the participants perceived themselves at low risk for diabetes.

CONCLUSIONS

This Latino sample had limited knowledge of diabetes risk factors and lifestyle changes that can prevent or delay diabetes onset. Insights for intervening for diabetes prevention are offered.

The sunless study: a beach randomized trial of a skin cancer prevention intervention promoting sunless tanning

OBJECTIVE

To examine the impact of a skin cancer prevention intervention that promoted sunless tanning as a substitute for sunbathing.

DESIGN

Randomized controlled trial.

SETTING

Public beaches in Massachusetts.

PARTICIPANTS

Women (N = 250) were recruited to participate in the study during their visit to a public beach. Intervention The intervention included motivational messages to use sunless tanning as an alternative to UV tanning, instructions for proper use of sunless tanning products, attractive images of women with sunless tans, a free trial of a sunless tanning product, skin cancer education, and UV imaging. The control participants completed surveys.

MAIN OUTCOME MEASURES

The primary outcome was sunbathing 2 months and 1 year after the intervention. Secondary outcomes included sunburns, sun protection use, and sunless tanning.

RESULTS

At 2 months, intervention participants reduced their sunbathing significantly more than did controls and reported significantly fewer sunburns and greater use of protective clothing. At 1 year, intervention participants reported significant decreases in sunbathing and increases in sunless tanning relative to control participants but no differences in the other outcomes.

CONCLUSION

This intervention, which promoted sunless tanning as an alternative to UV tanning, had a short-term effect on sunbathing, sunburns, and use of protective clothing and a longer-term effect on sunbathing and sunless tanning.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00403377.

Vagus nerve stimulation and emotional responses to food among depressed patients

BACKGROUND

Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste.

METHOD

Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering).

RESULTS

Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation.

CONCLUSIONS

This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.

Association of depressive symptoms and lifestyle behaviors among Latinos at risk of type 2 diabetes

Little is known about depression among Latinos at risk for type 2 diabetes. The purpose of this cross-sectional study was to determine the rate of depression in Latinos at risk for type 2 diabetes and to examine the associations between depressive symptoms, diet, physical activity, and body mass index (BMI; calculated as kg/m(2)). Latinos at risk for type 2 diabetes (n=210) were surveyed from July 2007 to August 2008. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Three 24-hour recalls were used to assess diet and physical activity. Linear regression analyses were used to examine the association between depression, BMI, and lifestyle factors. The sample (78% female) was largely of Caribbean origin (83%) and mean age was 52 years (standard deviation [SD]=11 years). Mean BMI was 34.2 (SD=5.9) and 77% were obese. Average CES-D score was 16.3 (SD=11.3; range=0-45) and 50% had CES-D score > or =16, suggesting clinical depression. Higher CES-D scores were associated with lower diet quality (P<0.05), but were not associated with BMI or physical activity. Depression and lower dietary quality can contribute to risk for type 2 diabetes among Latinos.

Association between adult attention deficit/hyperactivity disorder and obesity in the US population

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects approximately 2.9-4.7% of US adults. Studies have revealed high rates of ADHD (26-61%) in patients seeking weight loss treatment suggesting an association between ADHD and obesity. The objective of the present study was to test the association between ADHD and overweight and obesity in the US population. Cross-sectional data from the Collaborative Psychiatric Epidemiology Surveys were used. Participants were 6,735 US residents (63.9% white; 51.6% female) aged 18-44 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered. Diagnosis was defined by three categories: never met diagnostic criteria, met full childhood criteria with no current symptoms, and met full childhood criteria with current symptoms. The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Adult ADHD was associated with greater likelihood of overweight, (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.05, 2.38) and obesity (OR = 1.81; 95% CI = 1.14, 2.64). Results were similar when adjusting for demographic characteristics and depression. Mediation analyses suggest that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and both overweight and obesity. Results suggest that adult ADHD is associated with overweight and obesity.

Design and methods for a cluster randomized trial of the Sunless Study: a skin cancer prevention intervention promoting sunless tanning among beach visitors

Background

Skin cancer is the most prevalent yet most preventable cancer in the US. While protecting oneself from ultraviolet radiation (UVR) can largely reduce risk, rates of unprotected sun exposure remain high. Because the desire to be tan often outweighs health concerns among sunbathers, very few interventions have been successful at reducing sunbathing behavior. Sunless tanning (self-tanners and spray tans), a method of achieving the suntanned look without UVR exposure, might be an effective supplement to prevention interventions.

Methods and Design

This cluster randomized trial will examine whether a beach-based intervention that promotes sunless tanning as a substitute for sunbathing and includes sun damage imaging and sun safety recommendations is superior to a questionnaire only control group in reducing sunbathing frequency. Female beach visitors (N = 250) will be recruited from 2 public beaches in eastern Massachusetts. Beach site will be the unit of randomization. Follow-up assessment will occur at the end of the summer (1-month following intervention) and 1 year later. The primary outcome is average sunbathing time per week. The study was designed to provide 90% power for detecting a difference of .70 hours between conditions (standard deviation of 2.0) at 1-year with an intra-cluster correlation coefficient of 0.01 and assuming a 25% rate of loss to follow-up. Secondary outcomes include frequency of sunburns, use of sunless tanning products, and sun protection behavior.

Discussion

Interventions might be improved by promoting behavioral substitutes for sun exposure, such as sunless tanners, that create a tanned look without exposure to UVR.

Trial registration

NCT00403377

The multidimensional health locus of control scales: testing the factorial structure in sample of African American medical patients

OBJECTIVE

A fifth subscale was recently added to the widely used multidimensional health locus of control (MHLC) measure, and little is known about the factor structure of the MHLC with the new scale among African Americans from disadvantaged backgrounds. Also, few studies have examined differences in Health Locus of Control (HLOC) beliefs across medical patients from similar demographic backgrounds.

METHODS

We asked participants to complete a survey about HLOC beliefs and extracted biological markers from their medical charts. Participants were drawn from patients of internal medicine and infectious disease clinics at a charity hospital in Baton Rouge, Louisiana. In total, we surveyed 186 African American patients who were diagnosed with HIV/AIDS or type 2 diabetes.

RESULTS

Confirmatory factor analysis could not confirm a 5-factor structure; however, a new 3-factor structure was produced that includes 1) internal health beliefs, 2) external health beliefs, and 3) God health beliefs. Patients with HIV/AIDS reported more external and God HLOC beliefs than did patients with type 2 diabetes.

CONCLUSIONS

The factor structures that emerged from previous research may not be appropriate to use when conducting research with individuals from a low SES who are also from an ethnic/racial minority background. Our findings suggest a new 3-factor structure for the MHLC. Future research should examine whether patients with HIV/AIDS may benefit from interventions that target external beliefs to improve health behavior.

Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder

BACKGROUND

Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial.

METHODS AND DESIGN

This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174) will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg) at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake) of the intervention effect on weight change will also be examined.

DISCUSSION

Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes.

TRIAL REGISTRATION

NCT00572520.

The psychosocial vulnerability model of hostility as a predictor of coronary heart disease in low-income African Americans

The current study examined social support and stress as mediators of the hostility-coronary heart disease (CHD) relationship as suggested by the psychosocial vulnerability model in a sample of low-income African Americans. Among 95 CHD patients and 30 healthy controls, hostility was negatively correlated with social support, but was not related to minor stress. CHD patients endorsed higher levels of hostility; however, the relationship between hostility and CHD status was diminished once stress and social support were included in the model. This study lends partial support for the psychosocial vulnerability model of hostility in African Americans, but suggests that the relationship between hostility and stress may be impacted by socioeconomic status.

Translating the diabetes prevention program into a hospital-based weight loss program

OBJECTIVE

Intensive lifestyle interventions have established efficacy, but translation to real-world settings has not been well demonstrated. Using the diffusion of innovations model, we describe the adoption of the Diabetes Prevention Program (DPP) Lifestyle Intervention into a hospital-based program and report feasibility, acceptability, and outcomes.

DESIGN

Patients (N = 118; 72% female, mean age = 48.8, mean baseline body mass index = 43.3) were enrolled into 16 weeks of DPP.

MAIN OUTCOME MEASURE

Weight loss (kg) was measured at baseline and after treatment.

RESULTS

Mean weight loss after 16 weeks was 5.57 kg (SD = 4.6) or 4.6% of baseline weight, and 30% met the 7% weight loss goal. Outcomes are compared with those reported in the DPP trial. Most participants (90.4%) were satisfied with the service; however, only 56% were satisfied with their weight loss.

CONCLUSION

The DPP was successfully translated into a real-world clinic with some protocol modifications. Weight loss was modest among heavier patients with more comorbidities than the original DPP sample. Diffusion of innovations theory provides a useful framework for adopting evidence-based programs in the clinical setting.

Association of major depression and binge eating disorder with weight loss in a clinical setting

OBJECTIVE

Obesity has been linked to both major depressive disorder (MDD) and binge eating disorder (BED) in clinical and epidemiological studies. The present study compared weight loss among patients with and without MDD and BED who participated in a hospital-based weight loss program modeled after the Diabetes Prevention Program.

RESEARCH METHODS AND PROCEDURES

Of 131 obese patients who enrolled in treatment, 17% were diagnosed with MDD only, 13% were diagnosed with BED only, 17% were diagnosed with both MDD and BED, and 53% lacked either diagnosis in a pretreatment clinical interview.

RESULTS

After treatment, patients with MDD only attained 63% of the weight loss that non-depressed patients attained. Patients with BED only attained 55% of the weight loss that non-binge eaters attained. The effect of MDD on weight loss was not accounted for by the presence of BED or vice versa. Only 27% of patients with both MDD and BED achieved clinically significant weight loss compared with 67% of patients who had neither disorder. Results were not significantly altered when gender, age, and diabetes status were adjusted.

CONCLUSION

Both MDD and BED were prevalent among this obese clinical population, and each disorder was independently associated with worse outcomes. Research is needed to investigate how to increase the efficacy of behavioral weight loss programs for individuals with MDD and/or BED.

Attitudes Toward Health Care Providers and Appointment Attendance in HIV/AIDS Patients

Patients with HIV/AIDS are likely to have numerous interactions with health care providers (HCPs) during the course of their disease. Research has shown that satisfaction with one's HCP is related to better medication adherence in patients with HIV/AIDS. Although a patient's attitude toward his or her HCP is important, little has been done to assess how it relates to appointment attendance. The current study assessed how attitudes toward HCPs as well as social support and depression relate to outpatient appointment attendance. Further, this study used a newly developed, psychometrically valid scale to assess specific patient attitudes toward HCPs including those related to disease stigma. Participants were predominantly low-income African American men (N = 109) recruited from a public southern HIV clinic. Analyses indicated that attitudes toward HIV HCPs, social support, and medication status but not depression or satisfaction with social support were associated with appointment attendance.

Vagus nerve stimulation acutely alters food craving in adults with depression

Vagus nerve stimulation (VNS) is now available as a treatment for epilepsy and treatment-resistant depression. The vagus nerve plays a central role in satiety and short-term regulation of food intake and research suggests a relationship between VNS and weight loss. The underlying mechanisms of this relationship are unknown. The purpose of the current study was to determine whether acute cervical VNS might temporarily alter food cravings. Thirty-three participants were recruited for three groups; depression VNS, depression non-VNS, and healthy controls. Participants viewed 22 computerized images of foods twice in one session and completed ratings for food cravings after each image. The VNS participants' devices were turned on for one viewing of an image and off for the other (randomized order). Participants were blind to VNS condition (on versus off). Acute VNS device activation was associated with a significant change in cravings-ratings for sweet foods. A significant proportion of variability in VNS-related changes in cravings was accounted for by patients' clinical VNS device settings, acute level of depression, and body mass. Further studies are warranted addressing how acute or chronic VNS might modify eating behavior and weight.

A stage-targeted physical activity intervention among a predominantly African-American low-income primary care population

PURPOSE

To examine the efficacy of a stage-targeted physical activity intervention among low-income African-Americans.

METHODS

207 participants were randomly assigned to groups and administered baseline measures. Intervention participants were mailed stage-targeted physical activity information, whereas control participants received low-sodium diet brochures. Measures were readministered by phone 1 and 6 months later, with response rates of 69% and 46%, respectively.

RESULTS

69% of participants were African-American and 64% had a monthly household income of < $1000. A doubly-multivariate analysis of variance indicated that intervention participants reported more physical activity than control participants at 1 month (F(1, 204) = 4.03, p < .05). Unlike control participants, intervention participants reported significant stage progression at 1 month, according to a McNemar chi2 test. Gains attenuated by 6 months.

CONCLUSIONS

The current study supports the use of this intervention among low-income African-Americans. Limitations include use of self-report measures and small sample size.

Minor life events as predictors of medical utilization in low income African American family practice patients

This study assessed the ability of minor life events to predict medical utilization among 141 low-income, predominantly African American family practice patients. Subjects completed one year of stress assessments including major and minor life events. Four years of prospective medical utilization was collected, including outpatient, inpatient, and emergency department visits. Hierarchical regressions were conducted to assess the predictive value of minor life events for utilization, after controlling for demographic variables and major life events. The impact of minor life events was a significant predictor of outpatient utilization, accounting for 3.6% of the variance. Minor life events were unrelated to emergency department and inpatient visits. The relationship between minor life events and some types of utilization suggests traditional stress management techniques may be beneficial in reducing utilization for some patients, although such conclusions are tempered by the modest relationship between stress and utilization.

Prevalence of overweight and obesity within primary care clinics in a public hospital system

OBJECTIVE

The prevalence of obesity is especially high in low-income minority individuals, many of whom lack health insurance. The goal of the current study was to establish the prevalence of obesity in the primary care clinics at a public hospital that serves predominantly African-American indigent patients and to compare this prevalence to the national norm.

RESEARCH METHODS

Information from 845 patients attending four outpatient clinics was obtained via retrospective chart reviews. Age, gender, race, weight, and height were obtained, and body mass index (BMI) was calculated.

RESULTS

Eighty-four percent of patients were overweight or obese. The 20% prevalence of extreme obesity was especially high. The primary care clinics had more than twice the rate of obesity as the national norm, even when controlling for demographic characteristics.

DISCUSSION

Socioeconomic status and/or cultural influences are likely factors in the higher rate of obesity in this population. Because of this markedly elevated prevalence of obesity, especially extreme obesity, the need for intervention is critical.

Attitudes toward HIV Health Care Providers scale: development and validation

Patient attitudes toward their health care providers can play an important role in determining health behavior change. The frequency of contact with health care professionals and disease stigma makes assessing patients' perception of this relationship of particular interest in an HIV medical population. While past general satisfaction and attitude tools have been used to assess this construct, there is a need for an assessment tool specific to patient attitudes in an HIV setting. This study was designed to validate the Attitudes toward HIV Health Care Provider scale (AHHCP) in an HIV medical population. Principal components analysis of the AHHCP yielded a two-factor structure accounting for 53.3% of the total variance in attitudes toward health care providers. The two factors represented items concerning Professionalism and Emotional Support. The AHHCP was found to have good internal consistency (0.92) and convergent validity with a measure of patient satisfaction (r = 0.59). The results of the present study suggest that the AHHCP is a reliable and valid instrument for use in assessing patient attitudes toward their health care providers.