Colleen Spees

Differences in Amounts and Types of Physical Activity by Obesity Status in US Adults.

OBJECTIVES To describe the physical activity patterns across levels of obesity among US adults. METHODS The frequency, intensity, and duration of physical activities were compared across obesity status in 7695 adults from NHANES, 1999-2006. RESULTS Significantly more normal-weight adults engaged in moderate- and vigorous- intensity activities and for a longer duration than did their overweight or obese counterparts. Lower intensity, longer duration walking contributed to nearly half of all moderate activity among obese subjects. CONCLUSIONS Significant differences exist in intensity, frequency, and duration of physical activity by weight status. This information suggests a targeted approach to current physical activity interventions be explored.

Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases, poor diet quality, and inflammatory biomarkers in the United States.

OBJECTIVE The lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population. METHODS Data from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988-1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships. RESULTS Multivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR=1.35; 95% CI=1.09,1.66), all causes (HR=1.54; 95% CI=1.39,1.70), CVD (HR=1.62; 95% CI=1.38,1.90) and diabetes (HR=2.45; 95% CI=1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality. DISCUSSION Insurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.

Health behaviors and perceptions of cancer survivors harvesting at an urban garden.

OBJECTIVES To gather information about perceptions of personal health behavior change in cancer survivors following participation in an urban gardening program. METHODS This qualitative study used focus groups of adult cancer survivors with an open-ended question thread format. Data were transcribed and analyzed by identifying, coding, and categorizing primary patterns/themes. RESULTS Four overarching themes were identified: (1) greater dietary intake of produce; (2) improved mental and physical health; (3) enhanced sense of community and social support; and (4) challenges to long-term maintenance. CONCLUSIONS Perceptions of positive behavior changes associated with harvesting at an urban garden targeting cancer survivors may inform future community and health promotion interventions aimed at improving adherence to evidence-based lifestyle behavior guidelines for cancer survivorship.

Behavioral and Physiological Factors Associated With Selective Eating in Children With Autism Spectrum Disorder.

Selective eating is common in children with autism spectrum disorder (ASD), but it is not yet well understood. The objectives of this study were to examine a new definition of selective eating, compare behavioral measures between children with ASD and selective eating and those without selective eating, and determine relationships among behavioral measures and measures of selective eating. Participants were assigned to groups on the basis of number of foods eaten compared with a population-based sample. Results of one-way multivariate analysis of variance indicated no overall effect of group for challenging behaviors, sensory reactivity, or repetitive behaviors. Between-participant tests indicated that scores for compulsive behaviors were significantly lower (p = .036) for the selective eating group. Correlations were moderately strong among variables relating to food intake and behavioral variables, but were not significant between selective eating and behavioral variables. Further research is needed to validate the definition of selective eating and to identify targets for intervention.

The State of Food Mapping Academic Literature Since 2008 and Review of Online GIS-based Food Mapping Resources

Various mapping methodologies have been used to explore complex social, economic, and environmental components of the food system. Planning scholars, geographers, public health officials, and community organizations have created maps to better understand disparities in the food environment. This review provides an analysis of the nature of geographic information systems mapping in scholarly research and web-based food mapping since 2008. Our review of thirty-four journal articles and seventy web-mapping projects covers the purpose, study area, topics, methods, and application of food mapping research and initiatives. Scholars and community stakeholders will benefit from this review of methodologies to inform their research and policy initiatives.

Feasibility, Preliminary Efficacy, and Lessons Learned From a Garden-Based Lifestyle Intervention for Cancer Survivors.

BACKGROUND Cancer survivors remain at increased risk for secondary malignancies, comorbidities, and all-cause mortality. Lifestyle behaviors, such as diet and physical activity, are strongly linked to a decreased risk of chronic disease and improved health outcomes, yet a paucity of research has been conducted in this vulnerable population. METHODS Adult cancer survivors were recruited to participate in Growing Hope, an experimental single-group study designed to assess the feasibility and efficacy of a theory-driven and evidence-based intervention. For 4 months, 22 participants received group and individual education and had access to harvesting fresh produce at an urban garden. Data on program satisfaction, compliance, diet, and physical activity were collected via surveys; anthropometrics, blood values, and skin carotenoids were objectively measured. RESULTS The intervention resulted in significant improvements in consumption of fruits and vegetables (P = .003), decreased consumption of red and processed meats (P = .030) and sugar-sweetened beverages (P = .020). Levels of skin carotenoids, fasting blood glucose, and non-high density lipoprotein cholesterol were also significantly improved (P = .011, P = .043, and P = .05, respectively). CONCLUSIONS The results of this study support the feasibility and efficacy of a multifaceted, garden-based intervention for cancer survivors. In addition, these preliminary results demonstrate a positive impact aligning with the current lifestyle recommendations for cancer survivorship. Larger randomized controlled trials are warranted to define impact on sustained health outcomes.

Skipping breakfast is associated with lower diet quality in young US children

Background/objectivesBreakfast consumption has been shown to impact children’s growth and development, but the influence of breakfast skipping on total daily intakes is not known. The purpose of this study was to examine the differences in nutritional intakes and food consumption between children who consume breakfast versus those who do not.Subjects/methodsDietary recall data were assessed for 2-year-old to 5-year-old children (n = 3443) and 6-year-old to 12-year-old children (n = 5147) from NHANES 2005–2012. Dietary intakes and diet quality scores were compared across breakfast consumption and skipping with means and 95% confidence interval.ResultsChildren who skipped breakfast on the day of intake had significantly lower energy intakes for the total day (5911 vs 6723 kJ) but had greater energy intakes from non-breakfast meals and snacks. Children who skipped breakfast consumed nearly 40% of the day’s intake (2332 kJ of 5911 kJ) from snacks, with 586 kJ from snacks as added sugars. Breakfast skipping was also related to significantly lower intakes of fiber, folate, iron, and calcium intakes. Overall diet quality scores, as well as fruit, whole fruit, whole grains, dairy and empty calorie subscale scores were significantly better in children who ate breakfast.ConclusionsChildren who skipped breakfast presented poorer overall diet quality and lower total intakes commonly obtained at breakfast. To address missed opportunities, nutrition professionals should encourage children’s consumption of a nutritious breakfast to support overall diet quality.

Prostate Cancer and Li-Fraumeni Syndrome: Implications for Screening and Therapy

Li-Fraumeni Syndrome (LFS) is an autosomal dominant genetic disorder associated with mutations in the TP53 gene and characterized by a propensity to develop a variety of malignancies resulting in a shortened lifespan. We report a case of prostate cancer in a 50 year old male with LFS. Experimental studies suggest that TP53 mutations in prostate cancer are associated with therapeutic resistance to radiation, chemotherapy, and anti-androgens, implying that LFS men may experience more aggressive cancer biology with implications for therapeutic decisions. The potential of prostate cancer to develop earlier in LFS favors institution of screening at earlier ages.

How Adolescents and Parents Food Shopping Patterns and Social Interaction when Shopping is Associated with Dietary Outcomes in Rural Communities

Objective: The aim of this study was to: 1) Describe the bi-directional relationship between parent and adolescent food shopping patterns and behaviors. 2) Assess the association between adolescent and parent self-reported food shopping behaviors, dietary patterns and body mass index. Design: Cross-sectional survey. Setting: Four rural counties in Kentucky and Ohio, United States, 2013 Subjects: Adolescents, ages 13-18, and their primary caregiver who conducted at least 25% of the food shopping. Results: Close to 60% of adolescents report grocery shopping with their parent. There was almost complete agreement between the parent and adolescent for eating fast-food together (p=0.0069), but low agreement on purchasing food from convenience stores (p=0.15). Adolescents who purchase food from school vending, gas stations, and convenience stores combined often consumed more added sugars and sugar-sweetened beverages(SSB) (2.66 [95% CI 0.43, 4.90]). Lastly, those who shopped with a friend at a fast food establishment consumed more mean added sugars. Conclusion: Adolescents and parents are influenced by their social and food store shopping behaviors. Policies and interventions need to address cumulative shopping behavior practices and social interactions within these venues.

Racial Differences in Barriers to Blood Pressure Control in a Family Practice Setting

Objective: Hypertension prevalence in the African American community is greater than in all other ethnic groups. Cultural perceptions of health and disease introduce barriers to providing effective care. The purpose of this study was to identify racial differences in the perceived causes of hypertension, current behaviors performed to control blood pressure, and perceived barriers to preventing or treating hypertension. Methods: A self-administered survey of patients seen for medical care in a primary care network was conducted. The survey was developed to measure perceptions of hypertension etiology and treatments. Data from African American (n = 69) and Caucasian (n = 218) respondents were used to assess racial differences in perceptions of blood pressure control. Results: About half of respondents knew their current blood pressures. African American patients were significantly less likely to believe that hypertension was caused by a lack of exercise and obesity. Significantly more Caucasians were less likely to report cutting down on table salt and taking prescription medications for blood pressure control. Both African Americans and Caucasians believed that sodium reduction was the most easily changed behavior to control their blood pressure, while both groups identified weight loss as being the most difficult. Conclusion: Racial differences exist in the perceived causes and treatments of high blood pressure, indicating a need for further patient education. When treating and counseling patients, physicians and support staff members must be sensitive to racial diversity and strive to offer culturally relevant solutions, especially for behaviors perceived as most difficult to change.