Cheryl L. Albright

Incorporating physical activity advice into primary care ☆: Physician-delivered advice within the activity counseling trial

INTRODUCTIONnThe Activity Counseling Trial (ACT) was designed to compare the effectiveness of physician advice alone with physician advice plus behavioral counseling, provided by ACT-trained health educators, to increase levels of physical activity in healthy, sedentary patients. The objective was to determine health care providers adherence to the ACT protocol for delivering initial physician advice on physical activity and to determine providers satisfaction with the protocol.nnnMETHODSnFifty-four physicians or physician assistants from 11 primary care practices located in California, Texas, and Tennessee volunteered to participate as ACT-trained physicians. Providers were trained to integrate 3 to 4 minutes of initial physical activity advice into the routine office visits of sedentary patients, aged 35 to 75 years, with no acute or serious chronic conditions. This advice included assessment of current physical activities, advising the patient about an appropriate physical activity goal, and referring the patient to the health educator. Providers initialed forms to document delivery of advice, and ACT health educators recorded their advice on a computerized tracking system. A provider survey measured length of time spent advising patients about physical activity and provider satisfaction with the program.nnnRESULTSnNinety-nine percent of patients received the initial physician advice about physical activity. Eighty-three percent of the providers spent less than 5 to 6 minutes, and 46% spent the recommended 3 to 4 minutes providing advice. Sixty-three percent said the advice resulted in little or no increase in the length of an office visit, and 83% said participation was an asset to their clinics.nnnCONCLUSIONSnProviders incorporated brief physical activity advice into routine primary care visits with little disruption. Their response to the ACT advice protocol was positive and participation in the study was viewed as beneficial.

Perceived environmental predictors of physical activity over 6 months in adults: activity counseling trial.

PURPOSEnIn the present study, the authors extend previous cross-sectional findings by using a prospective design to determine whether physical and social environmental characteristics predict physical activity over 6 months.nnnDESIGNnInactive adults were recruited to the Activity Counseling Trial, a multicenter, randomized, controlled trial of physical activity intervention in primary care. Participants were 387 women and 474 men aged 35-75 years in 3 regions; 1/3 were minorities; 56% had some college education. Baseline perceived environmental variables were used to predict physical activity at 6 months, adjusting for experimental condition and other potential moderators.nnnMEASURESnThe validated 7-day physical activity recall interview was used to estimate minutes of moderate to vigorous physical activity. A standardized survey was used to measure social and physical environmental variables around the home and neighborhood.nnnRESULTSnWomen reporting no unattended dogs and low crime in their neighborhoods and men reporting frequently seeing people being active in their neighborhoods did 50-75 more minutes of physical activity per week than did those with different environmental characteristics. Interactions of environmental variables with age group suggested that older adults may be more affected by environmental variables than are younger adults.nnnCONCLUSIONSnSelf-reported social and physical environmental variables were significantly related to moderate to vigorous physical activity among a diverse sample of adults living in 3 regions of the United States. These prospective findings strengthen the conclusion from previous cross-sectional studies that environmental variables are important correlates of physical activity.

The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.

OBJECTIVESnThis study was undertaken to test the effectiveness of the Stanford Nutrition Action Program, an experimental trial to reduce dietary fat intake among low-literacy, low-income adults.nnnMETHODSnTwenty-four paired adult education classes (351 participants, 85% women, mean age = 31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-related data, body mass index, and capillary blood cholesterol were collected at baseline and at two postintervention follow-ups.nnnRESULTSnThe Stanford Nutrition Action Program classes showed significantly greater net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2) than the general nutrition classes; they also showed significantly greater reductions in the percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no significant differences in body mass index or blood cholesterol. All positive intervention effects were maintained for 3 months postintervention.nnnCONCLUSIONSnThe Stanford Nutrition Action Program curriculum, tailored to the cultural, economic, and learning needs of low-literacy, low-income adults, was significantly more effective in achieving fat-related nutritional changes than the general nutrition curriculum.

JOB STRAIN AND PREVALENCE OF HYPERTENSION IN A BIRACIAL POPULATION OF URBAN BUS DRIVERS

OBJECTIVESnIn this study we tested the association between occupational stress--as measured by job demands, decision latitude, and job strain--and hypertension in a population of 1396 Black and White bus drivers.nnnMETHODSnHeight, weight, blood pressure, and medical history were assessed by physical exam. Drivers completed a questionnaire assessing their work schedules, personal habits, and self-perceptions about job demands and decision latitude.nnnRESULTSnUnivariate analyses revealed significant inverse associations; lower levels of job demands and job strain were associated with a higher prevalence of hypertension for Blacks and Whites. After 12 confounding variables were controlled for, the association between these two measures of occupational stress and hypertension became nonsignificant. Decision latitude was also not significantly associated with hypertension.nnnCONCLUSIONSnOur findings are inconsistent with previous studies findings of a positive association between job strain and chronic diseases. The difference in results may be explained by our incorporation of individuals perceptions in the measurement of occupational stressors and our use of individuals from a single occupation with comparable job responsibilities and income, thus controlling for potential confounding by social class.

Restaurant Menu Labeling: Impact of Nutrition Information on Entree Sales and Patron Attitudes:

This study examined changes in sales of low fat/low cholesterol foods targeted in a restaurant menu labeling program. Sales of labeled items were tracked before and after the program was introduced, and a subsample of patrons were surveyed for information on visibility and comprehension of the menu labels. Two of the four restaurants had significant increases in the sales of targeted foods following labeling. Comparisons between patrons dining in restaurants which had an increase in sales (I—increase restaurants) to those dining in restaurants which had no overall shift in sales (NI—no increase restaurants) revealed no differences in patron awareness or compre hension of the menu labels. There were age and gender differences between I and NI restaurants, with I restaurants having proportionally more males, and a younger clientele. Taste was the primary reason given by patrons for their entree choice, regardless of whether or not it was labeled. In all four restaurants women and older patrons were more aware of the program and more responsive to its recommendations. These findings suggest that environmental strategies may be an effective method of encouraging dietary changes in the general population, but patron characteristics such as age and gender may influence receptivity to this type of intervention. Future studies aimed at developing effective point of purchase education programs should evaluate these patron characteristics and include more powerful behavior change strategies.

Nutrition assessment and counseling practices: attitudes and interests of primary care physicians.

This survey examined the nutrition-related practices and office services of primary care physicians, and their preferred nutrition topics and educational methods. Respondents were 960 physicians from across the United States who were members of the Society of General Internal Medicine. A four-page mailed questionnaire with 21 items queried background information, nutrition-related clinical practices and office support systems, perceived self-efficacy for nutrition assessment and counseling, and nutrition-related educational preferences. Two-thirds of the respondents said they personally provided nutrition counseling. They reported moderate selfefficacy for nutrition counseling and lower confidence for using specific relapse prevention strategies. Greatest interest in further education related to chronic disease prevention and nutrition for the elderly, provided in convenient formats for practicing physicians.

Asian women have greater abdominal and visceral adiposity than Caucasian women with similar body mass index

Background:In the Multiethnic Cohort Study, Japanese Americans (JA) have lower mean body mass index (BMI) compared with Caucasians, but show a higher waist-to-hip ratio at similar BMI values and a greater risk of diabetes and obesity-associated cancers.Objective:We investigated the abdominal, visceral and hepatic fat distribution in these Asian and Caucasian Americans.Design:A cross-sectional sample of 60 female cohort participants (30 JA and 30 Caucasians), of ages 60–65 years and BMIs 18.5–40u2009kgu2009m−2, underwent anthropometric measurements and a whole-body dual energy X-ray absorptiometry (DXA) scan: a subset of 48 women also had abdominal magnetic resonance imaging (MRI).Results:By design, JA women had similar BMIs (mean 26.5u2009kgu2009m−2) to Caucasian women (27.1u2009kgu2009m−2). JA women were found to have a significantly smaller hip circumference (96.9 vs 103.6u2009cm; P=0.007) but not a significantly lower DXA total fat mass (25.5 vs 28.8u2009kg; P=0.16). After adjusting for age and DXA total fat mass, JA women had a greater waist-to-hip ratio (0.97 vs 0.89; P<0.0001), DXA trunk fat (15.4 vs 13.9u2009kg; P=0.0004) and MRI % abdominal visceral fat (23.9 vs 18.5%; P=0.01) and a lower DXA leg fat mass (8.2 vs 10.0u2009kg; P=<.0001). Their MRI % subcutaneous fat (33.4 vs 30.2%; P=0.21) and % liver fat (5.8 vs 3.8%; P=0.06) did not significantly differ from that of Caucasian women.Conclusions:Our findings build on limited past evidence, suggesting that Asian women carry greater abdominal and visceral fat when compared with Caucasian women with similar overall adiposity. This may contribute to their elevated metabolic risk for obesity-related diseases.

Cigarette Advertisements in Magazines: Evidence for a Differential Focus on Women's and Youth Magazines

Cigarette advertisements in eight popular magazines from 1960 to 1985 were exam ined. The magazines were selected to represent different market segments, particularly women and youth. Across all eight magazines, the average num ber of cigarette ads per issue increased substantially following the 1971 television ban on cigarette ads. More over, beginning in the late 1960s and early 1970s, proportionately more ads were placed in womens and youth-oriented magazines than in magazines which targeted other population segments. These data suggest that the tobacco industry may have responded to decreases in the number of smokers and the per capita consumption of cigarettes with an enterprising attempt to recruit new smokers—particularly young people and women.

The Stanford faculty development program: A dissemination approach to faculty development for medical teachers

The Stanford Faculty Development Program, designed to improve the instructional skills of clinical teachers, uses a dissemination model to provide faculty development activities for medical schools across the country. Selected clinical faculty attend a month‐long training program at Stanford University Medical Center and then return to their home institutions to conduct seminars for their fellow faculty and for residents in one of three content areas: (a) principles and skills of clinical teaching, (b) the teaching of medical decision making, or (c) the teaching of clinical preventive medicine. Faculty from institutions affiliated with over one quarter of U.S. medical schools have participated in the program. From 1986 through 1991, the program has trained 67 seminar facilitators from 47 institutions who have then conducted training for over 500 faculty and 200 residents. The extent of dissemination indicates that this approach provides a feasible mechanism for delivering faculty development in a wide var...

Influence of Maternal Stress on Successful Participation in a Physical Activity Intervention: The IMPACT Project

ABSTRACT Few studies have examined the impact of motherhood on successful participation in physical activity (PA) interventions. The current study focused on mothers in the Increasing Motivation for Physical Activity or IMPACT study, which aimed to promote PA in sedentary, low-income, ethnically diverse women (74% Latina). The aim of this study was to determine whether certain maternal variables (e.g., number of children, number and intensity of maternal stressors) influenced successful participation in an 8-week, class-based, PA intervention. PA consisted of accumulating 30 minutes or more of moderate-intensity activities (e.g., walking) five or more days a week. Sixty-eight mothers (average age = 32 years) were assessed at baseline and 10 weeks. Paired comparison t-tests demonstrated a significant increase in PA-related energy expenditure from baseline to 10 weeks (p < 0.05). Furthermore, this increase in PA was significantly associated with a decrease in the number of maternal stressors reported over this time period (p < 0.01). Simultaneous regression analyses indicated that (1) having a higher number of maternal stressors at baseline was associated with lower class attendance (p ≤ 0.05) and (2) rating these maternal stressors (e.g., unable to control childrens behavior) as being more stressful at baseline was associated with lower levels of PA at 10 weeks (p ≤ 0.01), independent of the number of children at home. These results suggest that the number and intensity of perceived maternal stressors may negatively impact attempts to become more physically active. Interventions should address such stressors.