C. Keith Haddock

A study of the psychometric and predictive properties of the Fagerström Test for Nicotine Dependence in a population of young smokers.

This study examined the psychometric properties of the Fagerström Test for Nicotine Dependence (FTND) in a population (N = 7998) of young smokers entering US Air Force Basic Military Training (BMT). An exploratory factor analysis suggested that the FTND is comprised of two factors. The first factor, labeled Smoking Pattern, included items assessing the number of cigarettes smoked per day, time to first cigarette, difficulty refraining from smoking, and smoking when ill. The second factor, labeled Morning Smoking, consisted of two items measuring whether one smokes more in the morning and whether one would rather give up the first cigarette of the day or all others. The Smoking Pattern factor proved to have adequate internal consistency, impressive criterion-related validity, and was strongly related to smoking cessation 1 year following BMT. In contrast, the Morning Smoking factor demonstrated questionable psychometric properties and was not supported by a confirmatory factor analysis.

Weight Management Using the Internet: A Randomized Controlled Trial

BACKGROUND Most weight-loss research targets obese individuals who desire large weight reductions. However, evaluation of weight-gain prevention in overweight individuals is also critical as most Americans become obese as a result of a gradual gain of 1-2 pounds per year over many years. METHOD This study evaluated the efficacy of an Internet-based program for weight-loss and weight-gain prevention with a two-group, prospective, randomized controlled trial. A military medical research center with a population of 17,000 active-duty military personnel supplied 446 overweight individuals (222 men; 224 women) with a mean age of 34 years and a mean BMI of 29. Recruitment and study participation occurred 2003-2005 and data were analyzed in 2006. Participants were randomly assigned to receive the 6-month behavioral Internet treatment (BIT, n=227) or usual care (n=224). Change in body weight, BMI, percent body fat, and waist circumference; presented as group by time interactions, were measured. RESULTS After 6 months, completers who received BIT lost 1.3 kg while those assigned to usual care gained 0.6 kg (F((df=366))=24.17; I<0.001). Results were similar for the intention-to-treat model. BIT participants also had significant changes in BMI (-0.5 vs +0.2 kg/m(2); F((df=366))=24.58); percent body fat (-0.4 vs +0.6%; F((df=366))=10.45); and waist circumference (-2.1 vs -0.4 cm; F((df=366))=17.09); p<0.001 for all. CONCLUSIONS Internet-based weight-management interventions result in small amounts of weight loss, prevent weight gain, and have potential for widespread dissemination as a population health approach. TRIAL REGISTRATION NCT00417599.

Depression predicts disability in long-term chronic pain patients.

Purpose : Investigators have examined factors that predict treatment outcome and disability status in chronic pain patients, including psychopathology and personality characteristics with equivocal results. The purpose of this study was to evaluate the usefulness of personality characteristics, depression, and personality disorders in predicting disability status in pain patients with long-term follow-up. The setting was a rehabilitation hospital in Southern Sweden. Method : Subjects were 184 pain patients (mean age=43.4 (10.8) years; 72.8% female) who had no more than 365 sick leave days (Mean sick leave days=132.7 (128.2)) prior to the baseline personality and psychiatric evaluation. The baseline evaluation consisted of a psychiatric interview that included the administration of the Structured Clinical Interview for DSM-IV Screen Questionnaire (SCID-II), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Karolinska Scales of Personality (KSP). Disability status was assessed by insurance record review a minimum of two-and-a-half years after baseline evaluation. Results : Multivariate logistic regression suggests that age (OR=1.09, 95% CI=1.02-1.18; p =0.013), number of sick leave days prior to evaluation (OR=1.01, 95% CI=1.01-1.02; p =0.018), and baseline diagnosis of depression significantly predicted subsequent disability status (OR=7.04, 95% CI=1.15-42.93; p =0.034). Baseline personality traits and the diagnosis of a personality disorder were not useful predictors of disability status in our sample. Conclusions : These data suggest that depression, but not personality disorders characteristics, was an important disability predictor in chronic pain patients with extended follow-up.

The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort.

Objective: To examine the prevalence of overweight and obesity in firefighters. Methods: Body mass index (BMI), waist circumference, and body fat percentage (BF%) were assessed in 478 career and 199 volunteer male firefighters from randomly selected departments. Results: High prevalence rates of overweight + obesity (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were found in career (79.5%; 33.5%) and volunteer firefighters (78.4%; 43.2%). False-positive obesity misclassification based on BMI, compared to waist circumference and BF%, was low (9.8% and 2.9%, respectively). False negatives were much higher: 32.9% and 13.0%. Obese firefighters demonstrated unfavorable cardiovascular disease (CVD) profiles. Conclusions: The prevalence of overweight and obesity exceeded that of the US general population. Contrary to common wisdom, obesity was even more prevalent when assessed by BF% than by BMI, and misclassifying muscular firefighters as obese by using BMI occurred infrequently.

How Does the Built Environment Relate to Body Mass Index and Obesity Prevalence Among Public Housing Residents

Purpose. This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. Design. Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. Setting. Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800–m radius from center of housing development). Subjects. Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. Measures. Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of neighborhood physical activity resources. Neighborhood street connectivity was also measured. Results. Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p = .05) and between obesity prevalence and resource accessibility (p = .09), number of amenities (p = .04), and amenity quality (p = .04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71% of obesity variance (p < .05). Male gender and higher feature quality, F(11, 407)37.19 and 12.66, p < .001, predicted lower BMI among residents. Conclusion. Supportive neighborhood environments were related to lower obesity prevalence and lower BMI among residents.

Associations between the built environment and physical activity in public housing residents

BackgroundEnvironmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments.MethodsPhysical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis.ResultsParticipants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors.ConclusionThese results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with fewincivilities, as well as, greater street connectivity, are more likely to be physically active.

The association of smoking and the cost of military training

OBJECTIVE To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES Excess training costs as a result of premature discharge. RESULTS In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with

Evaluation of a culturally appropriate intervention to increase physical activity.

18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over

Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates.

130 million per year in excess training costs.

Psychometric characteristics of the General Well-Being Schedule (GWB) with African–American women

OBJECTIVE To evaluate a culturally appropriate intervention to increase activity in overweight Mexican American women. METHODS Participants were randomly assigned to a physical activity program or wait-list control. RESULTS Treated participants were not more active than controls at 6 or 12 months. In addition, we found no significant differences in the proportion of individuals who met an objective criterion for physical activity from baseline to 6 months in the treatment or control groups. CONCLUSION The intervention did not increase physical activity in this population. Differences in baseline activity and contamination of the control group may partially account for the outcome.