The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls

OBJECTIVE

To determine the efficacy of a 2-year obesity prevention program in African American girls.

DESIGN

Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention.

SETTING

Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee.

PARTICIPANTS

Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher.

INTERVENTIONS

Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention).

MAIN OUTCOME MEASURE

The BMI at 2 years.

RESULTS

The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years.

CONCLUSIONS

The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Childhood obesity: are we missing the big picture?

Childhood obesity is increasing worldwide, raising alarm about future trends of cardiovascular disease, diabetes and cancer. This article discusses what may underlie our failure to respond effectively to the obesity epidemic, and presents a wider perspective for future research and public health agendas. So far targeting individual-level determinants and clinical aspects of childhood obesity has produced limited success. There is growing interest in understanding the wider determinants of obesity such as the built environment (e.g. walkability), social interactions, food marketing and prices, but much needs to be learned. Particularly, we need to identify distal modifiable factors with multiple potential that would make them attractive for people and policymakers alike. For example, walking-biking-friendly cities can reduce obesity as well as energy consumption, air pollution and traffic delays. Such agenda needs to be driven by strong evidence from research involving multi-level influences on behaviour, as well as the study of wider politico-economic trends affecting people's choices. This article highlights available evidence and arguments for research and policy needed to curb the obesity epidemic. The upstream approach underlying these arguments aims to make healthy choices not only the most rational, but also the most feasible and affordable.

Correlates of adherence with transdermal nicotine

This correlational study examined the adherence rates of transdermal nicotine (TN) use among a population of males and females 18 years of age and older (N = 619) who received varying levels of behavioral intervention. Rates of patch adherence were assessed for demographic (e.g., gender, ethnicity, and age), income-, smoking- [e.g., baseline carbon monoxide (CO), nicotine dependence, and follow-up quit status], and treatment-related (e.g., condition, and drop status) variables. Loglinear and logistic regression analyses were performed to assess adherence rates. Results indicated that male gender [chi2(2, n = 485) = 20.39, P = .038], not dropping out of the study [chi2(2, n = 485) = 13.94, P < .001], and intensive treatment (compared to the standard care) [chi2(4, n = 485) = 14.96, P = .005] were associated with greater adherence to TN. Furthermore, patch adherence was associated with quit status at 6 months (OR = 2.47, CI = 1.56-3.91, P < .001) and 12 months (OR = 2.12, CI = 1.34-3.37, P = .001). Complete and partial patch adherence (compared to minimal/no adherence) were associated with a greater number of telephone intervention contacts completed (OR = 2.621, CI = 1.421-4.832, P = .002). Noteworthy however, was the lack of association between level of income and patch adherence. These findings suggest characteristics of those more and less likely to adhere to TN in research and clinical settings.

A worksite smoking intervention: a 2 year assessment of groups, incentives and self-help

Sixty-three companies in the Chicago area were recruited to participate in a worksite smoking cessation program. Participants in each worksite received a television program and newspaper supplement (part of a community-wide media campaign), and one of three conditions: (1) self-help manuals alone (M), (2) self-help manuals and incentives for 6 months (IM) or (3) maintenance manuals, incentives and cognitive-behavioral support groups for 6 months (GIM). Results at the 2 year assessment are examined using a random-effects regression model. In addition, various definitions of quit-rate commonly used in smoking cessation research are explored and the advantages of using a public health approach in the worksite are examined.

Prevalence and characteristics of energy underreporting in African-American girls

OBJECTIVE

To determine the frequency and characteristics of energy intake underreporting in African-American preadolescent girls as part of the Girls health Enrichment Multi-site Studies (GEMS).

METHODS AND PROCEDURES

Energy intake was summarized using the Nutrition Data System for Research software and computed as a 3-day average of 24-h dietary recalls. Physical activity was assessed by an accelerometer, basal metabolic rate (BMR) was estimated using the World Health Organization's prediction equation, and underreporting of caloric intake was based on the Goldberg equation.

RESULTS

Using a conservative criterion for determining energy underreporting, we classified 54.8% of the girls as underreporters; 45.2% were classified as plausible reporters. Factors related to underreporting included higher BMI (beta = -0.506, P < or = 0.001), older age (beta = -0.159, P = 0.001), greater unhealthy eating behaviors (beta = -0.118, P = 0.025), and higher self-efficacy for diet (beta = -0.098, P = 0.033).

DISCUSSION

Underreporting of dietary intake, specifically energy, is common in African-American preadolescent girls and can be partially explained by weight status and psychosocial variables. The extent of dietary underreporting in specific and high-risk populations is largely unknown and could be evaluated by routinely including a report of such an index in future research studies.

Memphis Girls health Enrichment Multi-site Studies (GEMS)

Obesity prevalence is increasing in the U.S., especially among children and minority populations. This report describes the design and baseline data of the ongoing Girls health Enrichment Multi-site Studies (GEMS) trial (Memphis site), which is testing the efficacy of a 2-year family-based intervention to reduce excessive increase in body mass index (BMI). This randomized, controlled trial conducted at community centers in Memphis, Tennessee requires major measurements at baseline and at 12 and 24 months post-randomization. The participants are healthy African-American girls and one parent/caregiver of each girl. Participating girls are of ages 8-10 years, with BMI>or=25th percentile of the CDC 2000 growth charts or with one overweight or obese parent/caregiver (BMI>or=25 kg/m(2)). The active intervention is designed to prevent excessive weight gain by promoting healthy eating habits and increasing physical activity. An alternative intervention (comparison group) promotes general self-esteem and social efficacy. The main outcome measure is the difference between the two treatment groups in the change in BMI at 2 years. Three hundred and three girls have been randomly assigned to receive the test intervention (n=153) or the alternative intervention (n=150). The two groups do not differ in baseline characteristics. At the time of enrollment, the mean age was 9 years, the mean BMI was 22 kg/m(2) (mean BMI percentile=77 th), and 41% were overweight (BMI>/=95th percentile using CDC 2000 growth charts). Participants' intake of fruits and vegetables (1.3 serving/day) and fats (36% kcal), and their participation in moderate-to-vigorous physical activity (20 min/day), did not meet national recommendations. The GEMS obesity prevention intervention targets improved diet and increased physical activity to reduce excessive weight gain in healthy African-American girls of ages 8-10.

Measurement of body composition in 8-10-year-old African-American girls: a comparison of dual-energy X-ray absorptiometry and foot-to-foot bioimpedance methods

OBJECTIVE

The purpose of this study was to evaluate body composition outcomes of foot-to-foot (FF) bioelectrical impedance (BIA) and dual-energy x-ray (DEXA) in 8 to 10-year-old African-American girls and, if different, to develop and cross-validate specific BIA prediction equations for this at-risk group.

METHODS

DEXA and FF-BIA body composition outcomes were analyzed in 183, 8-10-year-old African-American girls from the Memphis site of the Girls health Enrichment Multi-site Study (GEMS).

RESULTS

Mean body composition outcomes by FF-BIA and DEXA were significantly different (p<0.0001); therefore, population-specific equations were developed and cross-validated using split-sample, cross-validation methods. When equations were used, BIA and DEXA outcomes were significantly correlated (percent body fat [r=0.931], fat mass [r=0.985], and fat-free mass [r=0.944]). Mean predicted BIA measurements for body fat, fat mass, and fat-free mass were essentially equal to their counterpart DEXA measurements (t[182]=- 0.013, p = 0.897, t[182]=- 0.06, p=0.956, and t[182]=- 0.26, p=0.792, respectively). The Bland-Altman analysis revealed a significant slope for percent fat (p=0.009) and slopes approaching significance for fat mass (p=0.07) and fat-free mass (p=0.06).

CONCLUSION

Although FF-BIA and DEXA are not directly interchangeable in young African-American girls, these equations accurately estimated average percent fat, fat mass, and fat-free mass of the cross-validation sample of African-American girls. However, the application of this equation may result in potential underestimation or overestimation of fat with respect to DEXA measures in some populations.

Are posttraumatic stress and depressive symptoms pathways to smoking relapse after a natural disaster?

BACKGROUND

Smoking relapse is rarely examined in disaster research. Thus, this study investigated smoking relapse nine and eighteen months after Hurricane Katrina and identified pathways and conditions for this outcome.

METHODS

The data came from a prospective study of adult ever smokers who were living in New Orleans at the time Hurricane Katrina struck (n = 1003), and a comparison sample of Memphis residents (n = 1001) who were not directly impacted by the hurricane. Participants from both cities were recruited using random digit dialing and were surveyed nine and eighteen months after Hurricane Katrina. We assessed whether smoking relapse rates differed by city and evaluated potential mediators and moderators of this association using conditional process analysis.

RESULTS

Though the probabilities of smoking relapse, posttraumatic stress, and depressive symptoms were higher among New Orleans than Memphis participants, hurricane exposure did not indirectly affect smoking relapse through increases in posttraumatic stress and depressive symptoms. Instead, as the number of hurricane-related events increased so to did the probability of smoking relapse through increases in depressive (β = 0.08, SE = 0.03, p = .02) and posttraumatic stress symptoms (β=0.08, SE=0.04, p = .04). Social support lowered the probability of smoking relapse by protecting against increases in depressive and posttraumatic stress symptoms.

CONCLUSIONS

Posttraumatic stress and depressive symptoms mediated the effects of disaster exposure on smoking relapse, and this effect was most pronounced among survivors who reported disaster-related stressors. Former smokers heavily exposed to disasters may benefit from postdisaster interventions that reduce depressive and posttraumatic stress symptoms, which may prevent smoking relapse.

Racial Differences in Posttraumatic Stress Disorder Vulnerability Following Hurricane Katrina Among a Sample of Adult Cigarette Smokers from New Orleans

Although blacks are more likely than whites to experience posttraumatic stress disorder (PTSD) after a natural disaster, the reasons for this disparity are unclear. This study explores whether race is associated with PTSD after adjusting for differences in preexisting vulnerabilities, exposure to stressors, and loss of social support due to Hurricane Katrina using a representative sample of 279 black and white adult current and past smokers who were present when Hurricane Katrina struck, and identified it as the most traumatic event in their lifetime. Multiple logistic regression models evaluated whether differential vulnerability (pre-hurricane physical and mental health functioning, and education level), differential exposure to hurricane-related stressors, and loss of social support deterioration reduced the association of race with PTSD. Blacks were more likely than whites to screen positive for PTSD (49 vs. 39 %, respectively, p = 0.030). Although blacks reported greater pre-hurricane vulnerability (worse mental health functioning and lower educational attainment) and hurricane-related stressor exposure and had less social support after the hurricane, only pre-hurricane mental health functioning attenuated the association of race with screening positive for PTSD. Thus, racial differences in pre-hurricane functioning, particularly poorer mental health, may partially explain racial disparities in PTSD after natural disasters, such as Hurricane Katrina. Future studies should examine these associations prospectively using representative cohorts of black and whites and include measures of residential segregation and discrimination, which may further our understanding of racial disparities in PTSD after a natural disaster.

Identification of facilitators and barriers to participation in weight gain prevention research by African American girls

OBJECTIVE

The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program.

METHODS

A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed.

RESULTS

Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n=28) and Wave 5 (n=91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups.

CONCLUSION

Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.

Effects of Disasters on Smoking and Relapse: An Exploratory Study of Hurricane Katrina Victims

BACKGROUND

Psychosocial stress maintains cigarette use and precipitates relapse, but little is known about how natural disasters in particular affect smoking.

PURPOSE

To determine the feasibility of recruiting victims soon after a natural disaster for a survey study, and to assess the types and determinants of changes in smoking behavior resulting from exposure to the disaster.

METHODS

A convenience sample of 35 Hurricane Katrina refugees who had smoked more than 100 cigarettes in their lifetime were surveyed one month after the storm to evaluate changes in smoking behavior.

RESULTS

Among a small sample of former smokers, more than half relapsed after Katrina, citing stress, urge, and sadness. Among current smokers, 52% increased their smoking after Katrina by more than half a pack per day on average. Most individuals who increased their smoking or relapsed expressed interest in receiving cessation assistance within the next month.

DISCUSSION

Stress-related increases in smoking and relapse may be common after a natural disaster.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Health education professionals have an important role to play in responding to changes in tobacco use in the aftermath of disasters. Educational interventions to discourage tobacco use as a coping strategy may be especially warranted given the high level of interest expressed in smoking cessation.

Race differences in depression vulnerability following Hurricane Katrina

OBJECTIVE

This study investigated whether racial disparities in depression were present after Hurricane Katrina.

METHOD

Data were gathered from 932 New Orleans residents who were present when Hurricane Katrina struck, and who returned to New Orleans the following year. Multiple logistic regression models evaluated racial differences in screening positive for depression (a score ≥16 on the Center for Epidemiologic Studies Depression Scale), and explored whether differential vulnerability (prehurricane physical and mental health functioning and education level), differential exposure to hurricane-related stressors, and loss of social support moderated and/or reduced the association of race with depression.

RESULTS

A univariate logistic regression analysis showed the odds for screening positive for depression were 86% higher for African Americans than for Caucasians (odds ratio [OR] = 1.86 [1.28-2.71], p = .0012). However, after controlling simultaneously for sociodemographic characteristics, preexisting vulnerabilities, social support, and trauma-specific factors, race was no longer a significant correlate for screening positive for depression (OR = 1.54 [0.95-2.48], p = .0771).

CONCLUSIONS

The racial disparity in postdisaster depression seems to be confounded by sociodemographic characteristics, preexisting vulnerabilities, social support, and trauma-specific factors. Nonetheless, even after adjusting for these factors, there was a nonsignificant trend effect for race, which could suggest race played an important role in depression outcomes following Hurricane Katrina. Future studies should examine these associations prospectively, using stronger assessments for depression, and incorporate measures for discrimination and segregation, to further understand possible racial disparities in depression after Hurricane Katrina. (PsycINFO Database Record

An investigation of psychosocial factors in patients with upper abdominal pain: a comparison with other groups of surgical outpatients

The purpose of this study was to examine the personality patterns, levels of anxiety and the importance of life events in patients with upper abdominal pain and to compare these patients with other groups of patients attending a general surgical outpatient clinic. The relevance of age, sex and social class was also studied. The patient groups were compared on each of the psychological measures and no differences were found between the groups. In addition the data were subjected to principal component and discriminant analyses in order to determine whether the U.A.P. patients could be distinguished on the basis of a combination of indices. Both analyses failed to produce any distinguishing criteria for the U.A.P. patients. A number of other observations on these patients are also discussed but the overall results are more consistent with a non-specific model of stress and disease than with the idea of specific psychological factors being involved in the development of upper abdominal pain.

Measurement characteristics of dietary psychosocial scales in a Weight Gain Prevention Study with 8- to 10-year-old African-American girls

Few measurement instruments for children's eating behaviors and beliefs have been specifically validated for African-American children. Validation within this population is important because of potential cultural and ethnic influences. Objectives were to evaluate established and newly developed or adapted dietary psychosocial measures in a sample of 303 preadolescent African-American girls and their caregivers. Acceptable internal consistency (Cronbach's alpha > or = 0.70) was found for measures of girls' self-efficacy for healthy eating, outcome expectancies for healthy eating, positive family support for healthy eating and household availability of low-fat food and fruit, juice and vegetables (FJV). Evidence for concurrent validity was found with significant associations between self-efficacy for healthy eating and lower intake of energy (r = -0.17) and fat grams (r = -0.16). Greater FJV availability was associated with greater FJV intake (r = 0.14) and lower body mass index (BMI) in girls (r = -0.12). Positive family support for healthy eating was associated with higher BMI in girls (r = 0.41). These results contribute to the development of scales to evaluate prevention interventions related to dietary intake in African-American children.

Comparative electron microscopic features of normal intermediate and metaplastic pyloric epithelium

The ultrastructural appearance of surface epithelial cells of normal and abnormal pyloric epithelium is presented. In addition to areas of complete intestinal metaplasia (IM) an incomplete metaplasia is described which contains poorly differentiated mucous cells, goblet cells, an occasional immature absorptive cell as well as the mature mucus-secreting surface epithelial cells of normal pyloric epithelium. This type of epithelium frequently appeared hyperplastic and showed alterations in the surface microvilli, terminal webs, plasma membranes and mucin granules. Apical vesicles, small electron-dense bodies and larger electron-dense multivesicular bodies were also found in the intermediate cells of incomplete IM and in the mature absorptive cells of complete IM. The intermediate cells described here may be synonymous with the sulphomucin-secreting cells found in adenocarcinomas of the stomach and oesophagus.

Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial

Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.

Do current smokers use more cigarettes and become more dependent on nicotine because of psychological distress after a natural disaster?

Natural disasters increase nicotine dependence and cigarette consumption, but the exact mechanisms and conditions responsible for this increase are relatively unclear. This study explored whether posttraumatic stress and depressive symptoms were pathways to increased nicotine dependence and cigarette consumption after disaster exposure using a representative sample of current smokers who were living in New Orleans at the time Hurricane Katrina struck (n = 175), and a comparison sample of smokers from Memphis (n = 222) who were not directly impacted by Hurricane Katrina. We assessed whether nicotine dependence and daily cigarette consumption differed by city and evaluated potential mediators and moderators of this association using conditional process analysis. Results showed that though nicotine dependence (B = 0.46, SE = 0.20, p = .02) and average daily cigarette consumption (B = 2.19, SE = 0.80, p = .01) were higher among New Orleans than Memphis smokers 27 months after Hurricane Katrina, hurricane exposure did not indirectly affect nicotine dependence and average daily cigarette consumption through increases in posttraumatic stress and depressive symptoms. Smokers who are exposed to disasters may not be increasing their cigarette use and their dependency on nicotine because of post-disaster psychological distress. Future studies should investigate other mechanisms and conditions to explain post-disaster changes in smoking behavior.

Family context as it relates to weight-related behaviors in preadolescent African American girls

OBJECTIVE

To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls.

METHODS

Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial.

RESULTS

Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls' body image and weight control behaviors.

CONCLUSIONS

A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

Etalon-spectrograph system for improved resolution over a wide spectral range

In this system the Airy pattern from a scanning Fabry-Perot étalon is imaged onto the entrance slit of a diffraction grating spectrograph. The dispersed light from the spectrograph is, in turn, imaged onto a 500-channel vidicon tube for a digital output. If the free spectral range of the étalon is a few times greater than the wavelength dispersion per channel spacing on the vidicon, scanning the étalon across its free spectral range can reproduce the entire spectral region displayed by the spectrograph with approximately the resolution of the étalon.