Adama Brown

The Effect of a "Mindful Restaurant Eating" Intervention on Weight Management in Women.

OBJECTIVE To evaluate the effect of a Mindful Restaurant Eating intervention on weight management. DESIGN Randomized control trial. SETTING Greater metropolitan area of Austin, Texas. PARTICIPANTS Women (n = 35) 40-59 years old who eat out at least 3 times per week. INTERVENTION The intervention, using 6 weekly 2-hour, small group sessions, focused on reducing calorie and fat intake when eating out through education, behavior change strategies, and mindful eating meditations. MAIN OUTCOME MEASURES Weight, waist circumference, self-reported daily calorie and fat intake, self-reported calories and fat consumed when eating out, emotional eating, diet related self-efficacy, and barriers to weight management when eating out. ANALYSIS General linear models examined change from baseline to final endpoint to determine differences in outcomes between the intervention and control group. RESULTS Participants in the intervention group lost significantly more weight (P =.03), had lower average daily caloric (P = .002) and fat intake (P = .001), had increased diet-related self-efficacy (P = .02), and had fewer barriers to weight management when eating out (P = .001). CONCLUSIONS AND IMPLICATIONS Mindful Restaurant Eating intervention was effective in promoting weight management in perimenopausal women.

Menopausal symptoms among four major ethnic groups in the United States.

The purpose of the study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States. This study was done via a cross-sectional Internet survey among 512 midlife women recruited using a convenience sampling. The instruments included questions on background characteristics, ethnicity-related factors, health, and menopausal status and the Midlife Women’s Symptom Index. The data were analyzed using descriptive and inferential statistics. Significant ethnic differences were found in the total number and severity of the symptoms. The most frequently reported symptoms and predictors of the total number and severity of the symptoms differed by ethnic identity. More in-depth cultural studies are needed to understand the reasons for the ethnic differences in menopausal symptom experience.

Predictors of dietary quality in low-income pregnant women: A path analysis

Background:Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. Objective:The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. Method:A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. Results:The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (&bgr; = .36) and a direct (&bgr; = −.23) and indirect effect on dietary quality (&bgr; = −.30). Poor eating habits had a direct effect on dietary quality (&bgr; = −.18). Social support had no effect on dietary quality. Age had significant direct effects on education (&bgr; = .39) and nutritional knowledge (&bgr; = .18) and an indirect effect on dietary quality (total effect, &bgr; = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. Discussion:Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Risk factors for excessive or inadequate gestational weight gain among Hispanic women in a U.S.-Mexico border state.

OBJECTIVE To identify risk factors for excessive or inadequate gestational weight gain and associated morbidities among Hispanic women in a U.S.-Mexico border state. DESIGN Case-control design. SETTING New Mexico. PARTICIPANTS Hispanic women responding to the New Mexico Pregnancy Risk Assessment Monitoring System 2000 to 2003; 1,597 women in final excessive versus adequate gestational weight gain analyses and 1,351 in final inadequate versus adequate gestational weight gain analyses. METHODS Information from birth certificates and Pregnancy Risk Assessment Monitoring System questionnaires were use in logistic regression analyses to identify risk factors and associated events. RESULTS Prevalence of excessive gestational weight gain was 35.7%, while inadequate gestational weight gain was 30.4%. Among factors associated with increased risk of excessive gestational weight gain were overweight (odds ratio [OR]=2.87, 95% confidence interval [CI]=2.11, 3.90) or obese status (OR=1.82, 95% CI=1.38, 2.39), whereas residing in a U.S.-Mexico border county reduced such risk (OR=0.75, 95% CI=0.59, 0.97). Among risk factors for inadequate gestational weight gain were gestational diabetes (OR=1.58, 95% CI=1.05, 2.37) and inadequate prenatal care (OR=2.17, 95% CI=1.56, 3.02). After adjusting for confounders, inadequate gestational weight gain increased risk of low birth weight (OR=l.92, 95% CI=1.11, 3.29), while excessive gestational weight gain reduced this risk (OR=0.29, 95% CI=0.12, 0.68) but increased risk of macrosomia (OR=2.07, 95% CI=1.32, 3.25). CONCLUSION Prepregnant overweight and obese status were among factors associated with excessive gestational weight gain among Hispanic women, whereas inadequate prenatal care was among factors associated with increased risk of inadequate gestational weight gain.

Depression and Adherence to Lifestyle Changes in Type 2 Diabetes A Systematic Review

Purpose Depression affects millions of people worldwide and is prevalent among those with diabetes. The purpose of this review was to synthesize recent research on depression and adherence to dietary and physical activity recommendations in persons with type 2 diabetes (T2DM). Methods This systematic review is a subanalysis of an NIH-funded model-testing meta-analysis. Thirteen electronic databases were searched using terms: depression, adherence, T2DM, diabetes. Selected studies: were reported in English between 2000 and 2012, focused on adults with T2DM, and measured depression and dietary and/or physical activity adherence. Results Twenty-seven studies involving 7266 participants were selected; participants were 54% female and 62 years of age, on average. When reported, depression prevalence in study samples ranged from 4.5% to 74%. Six intervention studies targeted diabetes treatment, with or without depression treatment; no studies focused solely on treating depression. Twenty-one descriptive studies examined relationships between depression and diet/physical activity adherence, finding a negative association. Only 2 of the 6 intervention studies examined this relationship; findings were inconsistent. Conclusion Depression was associated with lower adherence to diabetes self-care, as evidenced primarily by descriptive studies; results of intervention studies were conflicting. Future research should focus on the effects of treating depression on diabetes health outcomes.

“Physical Activity as a Luxury”: African American Women’s Attitudes Toward Physical Activity

The purpose of this study was to explore African American midlife women’s attitudes toward physical activity. Using a feminist perspective, a 6-month online forum was conducted with 21 African American midlife women recruited on the Internet. The data were analyzed using thematic analysis. Four themes emerged: (a) culturally acceptable body, (b) missed opportunity to learn, (c) physical activity as a luxury, and (d) want to do by myself. The women had positive body images regardless of their actual weight. The women considered physical activity “a luxury” in their busy lives and thought that they had already missed opportunities to learn. The women wanted to participate in physical activities alone because of their bad childhood experiences and hesitance to go out in public with sweaty, messy hair. The findings suggested that unique programs that promote physical activity should be developed that consider the women’s ethnic-specific attitudes.

A national multiethnic online forum study on menopausal symptom experience.

Background: Little is known about how culture influences menopausal symptom experience, and few comparative qualitative studies have been conducted among multiethnic groups of midlife women in the United States. Objectives: The purpose of this study was to explore commonalities and differences in menopausal symptom experience among four major ethnic groups in the United States (Whites, Hispanics, African Americans, and Asians). Methods: This was a secondary analysis of qualitative data from a larger national Internet-based study. The qualitative data from 90 middle-aged women in the United States who attended four ethnic-specific online forums of the larger study were examined using thematic analysis. Results: The themes reflecting commonalities across the ethnic groups were just a part of life, trying to be optimistic, getting support, and more information needed. The themes reflecting the differences among the ethnic groups were open and closed, universal and unique, and controlling and minimizing. Overall, the findings indicated positive changes in womens menopausal symptom experience and supported the existence of cultural influences on womens menopausal symptom experience across the ethnic groups. Discussion: Systematic efforts need to be made to empower midlife women in their management of menopausal symptoms.

Evaluating the effect of an asthma self-management intervention for rural families.

Abstract Objective: To present outcomes of an asthma self-management educational intervention delivered to children (grades 2–5) at school and to parents in a home visit. Methods: The intervention effectiveness was tested in a 12-month longitudinal study with randomization by elementary schools into treatment and attention-control groups with 183 children who had a diagnosis of asthma. Data were collected at four time points. Change over time was examined with linear mixed models. Results: Quality of life (QOL), hospitalizations, and emergency department visits improved significantly for all the children. African American and Mexican American children had worse asthma-related QOL than did White children. Asthma management behaviors, asthma self-efficacy, and coping likewise improved with girls improving significantly more than the boys. Significant improvements in inhaler skill and asthma severity were seen in the treatment group children when compared to the control group. Treatment group parents showed significant improvements in home asthma management and self-efficacy. Conclusions: The improvement in inhaler skill is an important finding for practitioners as this is a behavior that can be addressed in the clinical setting. The reduction in the treatment group’s asthma severity scores may reflect the improvement in medication delivery as their inhaler skill improved. The differential improvement between boys and girls points to the need for testing other formats in asthma education that can address different learning styles. The individualized parent asthma education enabled the intervener to incorporate neighborhood and home environmental information thereby allowing for tailoring of parental instruction.

Disparities in smoking behaviors among those with and without disabilities from 2001 to 2005.

OBJECTIVES Past research has suggested smoking disparities among individuals with disabling conditions. We contrasted smoking behaviors of those with and without disabilities from 2001 to 2005. DESIGN Descriptive correlational study. SAMPLE Telephone interviews were conducted in all states with noninstitutionalized adults. Half were female; most were Anglo (70.5%) and had at least a high school education (90%). Their average age was 45 years. Approximately 19% of the sample reported being disabled. MEASUREMENT We analyzed 4 years of data from the population-based Behavioral Risk Factor Surveillance System. RESULTS While individuals with disabilities were more likely to report ever having smoked than nondisabled respondents, current smoking behaviors were more similar in the 2 groups, and the difference was not statistically significant when demographic factors were included in the model. Smoking behavior decreased somewhat for nondisabled persons between 2001 and 2005, but remained fairly constant for those with disabilities. However, those with disabilities were more likely than those without disabilities to have attempted to quit smoking in all years. CONCLUSIONS Findings underscore the importance of smoking cessation programs tailored to people with disabilities. The role of the public health nurse in addressing smoking cessation at the individual, system, and community level is discussed.

Acculturation and biobehavioral profiles in pregnant women of Hispanic origin: generational differences.

In Hispanics, acculturation may lead to negative health outcomes. This study used a cross-sectional design to investigate the psychosocial and biological risks in acculturating pregnant women of Hispanic origin (n = 470). Psychosocial risks—depressive symptoms, anxiety, and stress—were assessed by self-report, whereas biological measures included stress-related and reproductive hormones. Mental health deteriorated across generations, with worsening depression, anxiety, and stress with successive generations. Stress and reproductive hormone levels decreased across generations, whereas body mass index and number of sexual partners increased. These data provide potential biobehavioral explanations of the relationship between acculturation and declining health among Hispanic women in the United States.