Psychological and neural contributions to appetite self-regulation

OBJECTIVE

This paper reviews the state of the science on psychological and neural contributions to appetite self-regulation in the context of obesity.

METHODS

Three content areas (neural systems and cognitive functions; parenting and early childhood development; and goal setting and goal striving) served to illustrate different perspectives on the psychological and neural factors that contribute to appetite dysregulation in the context of obesity. Talks were initially delivered at an NIH workshop consisting of experts in these three content areas, and then content areas were further developed through a review of the literature.

RESULTS

Self-regulation of appetite involves a complex interaction between multiple domains, including cognitive, neural, social, and goal-directed behaviors and decision-making. Self-regulation failures can arise from any of these factors, and the resulting implications for obesity should be considered in light of each domain. In some cases, self-regulation is amenable to intervention; however, this does not appear to be universally true, which has implications for both prevention and intervention efforts.

CONCLUSIONS

Appetite regulation is a complex, multifactorial construct. When considering its role in the obesity epidemic, it is advisable to consider its various dimensions together to best inform prevention and treatment efforts.

Social Neuroscience: Progress and Implications for Mental Health

Social neuroscience is a new, interdisciplinary field devoted to understanding how biological systems implement social processes and behavior. Social neuroscience capitalizes on biological concepts and methods to inform and refine theories of social behavior, and it uses social and behavioral constructs and data to inform and refine theories of neural organization and function. We focus here on the progress and potential of social neuroscience in the area of mental health. Research in social neuroscience has grown dramatically in recent years. Among the most active areas of research we found are brain-imaging studies in normal children and adults; animal models of social behavior; studies of stroke patients; imaging studies of psychiatric patients; and research on social determinants of peripheral neural, neuroendocrine, and immunological processes. We also found that these areas of research are proceeding along largely independent trajectories. Our goals in this article are to review the development of this field, examine some currently promising approaches, identify obstacles and opportunities for future advances and integration, and consider how this research can inform work on the diagnosis and treatment of mental disorders.

Like parent, like child: child food and beverage choices during role playing

OBJECTIVE

To examine food and beverage choices of preschool-aged children.

DESIGN

Semistructured observational study. While pretending to be adults during a role-play scenario, children selected food and beverage items from a miniature grocery store stocked with 73 different products, of which 47 foods and beverages were examined in this analysis. Parents self-reported how frequently they purchased specific grocery items.

SETTING

A behavioral laboratory.

PARTICIPANTS

One hundred twenty children, aged 2 to 6 years, and 1 parent for each child. Main Outcome Measure Children's total purchases were classified according to the number of healthier and less healthy products they selected as least healthy, somewhat healthy, and most healthy choices. The same categories were used to classify parents' self-reported purchases.

RESULTS

Most of the children (70.8%) purchased foods that were categorized as least healthy choices. Only 13 children (10.8%) had shopping baskets consisting of the healthiest choices. On average, children in the group with the least healthy choices purchased the same number of healthier and less healthy products, whereas children in the group with most healthy choices purchased 5 healthier products for each less healthy product selected. The healthfulness of children's total purchases were significantly (P = .02) predicted by their parents' purchasing categorization.

CONCLUSIONS

When presented with a wide array of food products, young children chose combinations of healthier and less healthy foods and beverages. The data suggest that children begin to assimilate and mimic their parents' food choices at a very young age, even before they are able to fully appreciate the implications of these choices.

Modifying exposure to smoking depicted in movies: a novel approach to preventing adolescent smoking

BACKGROUND

Most behavioral approaches to adolescent smoking address the behavior directly. We explore an indirect approach: modifying exposure to portrayals of smoking in movies.

OBJECTIVES

To describe adolescents' exposure to smoking in movies and to examine factors that could modify such exposure.

DESIGN

Occurrences of smoking were counted in each of 601 popular movies. Four thousand nine hundred ten northern New England junior high school students were asked to report which movies they had seen from a randomly generated subsample of 50 films, and responses were used to estimate exposure to the entire sample. Analysis The outcome variable was exposure to movie smoking, defined as the number of smoking occurrences seen. Risk factors for exposure included access to movies (movie channels, videotape use, and movie theater); parenting (R [restricted]-rated movie restrictions, television restrictions, parenting style); and characteristics of the child (age, sex, school performance, sensation-seeking propensity, rebelliousness, and self-esteem). We used multiple regression to assess the association between risk factors and exposure to movie smoking.

RESULTS

Subjects had seen an average of 30% of the movie sample (interquartile range, 20%-44%), from which they were exposed to 1160 (interquartile range, 640-1970) occurrences of smoking. In a multivariate model, exposure to movie smoking increased (all P values <.001) by about 10% for each additional movie channel and for every 2 videos watched per week. Exposure increased by 30% for those going to the movie theater more than once per month compared with those who did not go at all. Parent restriction on viewing R-rated movies resulted in a 50% reduction in exposure to movie smoking. There was no association between parenting style and exposure to movie smoking. Much of the protective effect of parent R-rated movie restriction on adolescent smoking was mediated through lower exposure to movie smoking.

CONCLUSIONS

Adolescents see thousands of smoking depictions in movies, and this influences their attitudes and behavior. Exposure to movie smoking is reduced when parents limit movie access. Teaching parents to monitor and enforce movie access guidelines could reduce adolescent smoking in an indirect, yet powerful, manner.

Effect of cigarette promotions on smoking uptake among adolescents

BACKGROUND

The purpose of this study was to evaluate the association between receptivity to cigarette promotions and smoking uptake in a cohort of adolescents.

METHODS AND MEASURES

This was a prospective cohort study of 480 4th- to 11th-grade students conducted in three rural Vermont K-12 schools. Cigarette use was determined by self-report at baseline, 12 months (survey 2), and 21 months (survey 3). Proportional odds models were used to evaluate smoking uptake as a function of baseline measures of cigarette use, receptivity to cigarette promotions, and confounding factors, including grade, parental education, peer smoking, and family smoking. Adolescents were receptive to cigarette promotions if they owned or were willing to use a personal item bearing a cigarette brand logo [cigarette promotional item (CPI)]. Smoking status was measured using a 6-point ordinal index that combined experience and attitudes: 0 = never smoker/not susceptible to smoking, 1 = never smoker/susceptible to smoking, 2 = puffer (1 cigarette or less in lifetime), 3 = non-current experimenter (2-99 cigarettes in lifetime/none in past 30 days), 4 = current experimenter, and 5 = smoker (> or =100 cigarettes in lifetime).

RESULTS

The 480 students were equally distributed across grade at baseline. Environmental exposure to smoking was high, and 30% were receptive to cigarette promotions at baseline. Higher levels on the smoking index at baseline were associated with higher grade in school, peer smoking, and receptivity to cigarette promotions. One hundred eighty-five students (38.5%) had moved to a higher category on the smoking index by survey 3, of whom 30 had become smokers. Receptivity to cigarette promotions at baseline was significantly associated with higher smoking uptake, with 48.7% of receptive students moving up one or more categories on the smoking index [adjusted proportional odds 1.9 (95% CI 1.3, 2.9)]. Acquisition of receptivity to cigarette promotions was also associated with increased smoking uptake, with those becoming receptive in surveys 2 or 3 having significantly higher odds of progression [3.6 (1.8, 7.0) and 2.9 (1.5, 5.5), respectively] compared with those who did not change. Conversely, those who were receptive at one point but became non-receptive in surveys 2 or 3 had lower odds of progression [0.4 (0.2, 0.9) and 0.5 (0.3, 1.1), respectively].

CONCLUSIONS

This study supports a close linkage between tobacco promotional activities and uptake of smoking among adolescents beyond baseline descriptions of receptivity to cigarette promotions. Over time, the likelihood of smoking uptake is increased when an adolescent acquires a CPI or becomes willing to use one and is decreased when an adolescent who owns a CPI loses it or becomes unwilling to use it. This provides strong evidence that elimination of cigarette promotional campaigns could reduce adolescent smoking.

Weight dissatisfaction and weight loss attempts among Canadian adults. Canadian Heart Health Surveys Research Group

OBJECTIVE

To describe the pattern of weight dissatisfaction and weight loss attempts among Canadian adults and the reasons for and methods of weight loss among those trying to lose weight.

DESIGN

Population-based, cross-sectional surveys.

SETTING

Ten Canadian provinces between 1986 and 1992.

PARTICIPANTS

A probability sample of 29,855 men and women aged 18 to 74 years was selected using provincial health insurance registration files; this paper describes the subsample of 19,841 (66%) participants from whom anthropometric data were collected.

OUTCOME MEASURES

Discrepancy between actual and desired body mass index (BMI); attempts to lose weight; reasons for losing weight; methods of weight loss used.

RESULTS

Whether their weight was in the acceptable range (BMI 20-24 kg/m2) or at a level of increasing risk (BMI > or = 27 kg/m2), women were more likely than men to wish they weighed less and to be trying to lose weight; almost two-thirds of women but less than half the men with BMI > or = 27 kg/m2 were trying to lose weight. Even among those with BMI 20-24 kg/m2, 32% of women (v. 10% of men) were trying to reduce their weight. Weight dissatisfaction and current and past weight loss attempts were all negatively associated with age among women, but were unrelated to age among men. People with higher ratios of waist to hip circumference (WHR), controlling for BMI, were no more likely to be trying to lose weight than those with lower WHR; in fact, for women with BMI 27-29 kg/m2, WHR was negatively associated with prevalence of weight loss attempts. The presence of diabetes, hypertension and hypercholesterolemia was also unrelated to weight loss attempts; regular smokers and sedentary people were less likely to report trying to lose weight, controlling for BMI. Among those currently trying to lose weight, the most commonly mentioned reason was to improve general health, followed by increasing attractiveness. Overall, the most frequently mentioned method of weight loss was dieting, followed by exercise.

CONCLUSIONS

Substantial numbers of men whose BMI places them at increased health risk appear to be content with their weight and are not attempting to reduce it. Conversely, women, especially the young and middle-aged, are likely to consider themselves above their desired weight and to be trying to lose weight, even when their weight is within acceptable limits. This reinforces the need to consider differences between men and women in efforts to promote and support healthy weights among Canadians.

Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI

In two independent studies, we explored the usefulness of three self-report measures of tobacco dependence--the Fagerström Tolerance Questionnaire (FTQ), the Fagerström Test for Nicotine Dependence (FTND), and the Heavy Smoking Index (HSI). The FTND is a revised version of the FTQ. The HSI is identical to a two-question subset of the FTND. Study 1 involved 932 participants in a seven-session, five-week, group smoking cessation program, and it looked at the ability of these self-report tests to predict expired air carbon monoxide (i.e., heaviness of smoking) at beginning of treatment and cessation at end of treatment. Study 2 involved 1877 participants in a self-help smoking cessation program, and it looked at the prediction of cessation at 16-month follow-up. All tests made statistically reliable predictions of smoking cessation, but generally accounted for little variance (about 1%). In Study 1, the test scores were associated positively with carbon monoxide levels. The shorter (six vs. eight questions), more reliable FTND is to be preferred to the FTQ; and the HSI (two questions) works as well as the FTND. Evidence is presented that suggests that samples of high-scoring smokers will not be well differentiated from the mid-range to the high-end of the scores.