David R. Black

Change in Diet, Physical Activity, and Body Weight in Female College Freshman.

OBJECTIVE To examine diet, physical activity, and body-weight changes associated with relocation from home to university. METHODS Diet, fitness/physical activity, body-weight parameters and self-efficacy were assessed among 54 freshman women upon college entry and 5 months later. RESULTS Although caloric intake significantly decreased, a significant increase occurred in body-weight parameters that may be attributed to significant decreases in total physical activity. CONCLUSIONS Interventions are needed aimed at increasing physical activity; improving diet quality related to consumption of vegetables, fruits, breads and pasta, and meats; and decreasing alcohol consumption.

Body mass index and disability in adulthood: a 20-year panel study.

OBJECTIVES This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. METHODS The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. RESULTS Obesity (BMI > or = 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. CONCLUSIONS Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.

A meta-analytic evaluation of couples weight-loss programs.

Applied Hedges and Olkins (1985) statistical meta-analytic procedures to summary data from all published studies that compared behavioral weight-control programs that formally involved partners in treatment (couples programs) to similar programs in which subjects participated alone (subject-alone programs). Based on tests of effect sizes, couples programs are significantly superior to subject-alone programs at posttreatment (p less than .05). A nearly significant (p = .06) statistical superiority for couples programs versus subject-alone programs is also found at 2- to 3-month follow-up, but not thereafter. The couples programs differed in the kinds of social support provided by partners, and the most productive kinds of partner support remain to be identified. In particular, the use of partners in providing social support to subjects after formal therapy has ended is still an area of largely unexplored potential.

Nutrition education worksite intervention for university staff: application of the health belief model.

OBJECTIVE To evaluate the efficacy of an 8-week worksite nutrition education intervention for university staff using the Health Belief Model (HBM) to promote healthful dietary behaviors that reduce risks for cardiovascular disease and cancer. DESIGN 2 3 2 repeated measures baseline/posttest ex post facto research design. PARTICIPANTS Staff employees were randomly assigned to treatment (n = 28) and control groups (n = 25). INTERVENTION The intervention focused on specific health beliefs, nutrition knowledge, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES Dependent variables were specific health beliefs, nutrition knowledge, and dietary behaviors. Independent variables were demographic characteristics and group assignment. ANALYSES Tests of parametric assumptions, power analyses, analysis of variance, and Kuder-Richardson and Pearson product-moment coefficients were computed and specificity of treatment effects was assessed. RESULTS Perceived benefits of healthy nutrition practices and nutrition knowledge related to cardiovascular disease and cancer significantly improved among the treatment participants, P <.001. Treatment group participants also significantly reduced total calories, fat, saturated fat, and cholesterol intake (each P <.001). CONCLUSIONS The intervention appears to be related to treatment effects and significantly increased nutrition knowledge and decreased energy, fat, saturated fat, and cholesterol intake to levels consistent with national recommendations.

Nutrition Education Intervention for College Female Athletes

OBJECTIVE To evaluate the efficacy of a nutrition education intervention for college female athletes to improve nutrition knowledge, build self-efficacy with respect to making healthful dietary choices, and improve dietary intake. DESIGN A pretest-posttest control group design was implemented. PARTICIPANTS A womens soccer team (n =15) and a womens swim team (n = 15) were randomly assigned to experimental and control groups, respectively. INTERVENTION The intervention focused on nutrition knowledge, self-efficacy in making healthful dietary choices, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES Dependent variables were nutrition knowledge, self-efficacy, and dietary practices. Independent variables were group assignment. ANALYSES The Mann-Whitney U test was used to analyze the results between groups, and the Fisher exact probability test was used to detect differences between groups in the number of positive dietary changes. RESULTS Treatment participants significantly improved nutrition knowledge, self-efficacy (P <.05), and the overall number of positive dietary changes (P <.03). CONCLUSIONS This study reduces the paucity of nutrition education intervention research among athletes and demonstrates the ability to increase not only nutrition knowledge, which is typically reported, but also self-efficacy and improvement in overall positive dietary changes during an 8-week intervention.

Synthesis of Intervention Research to Modify Physical Activity and Dietary Behaviors

A descriptive literature review was conducted to examine conceptual and methodological issues of interventions aimed at improving both physical activity and diet behaviors according to critical elements established by Sidani and Braden (1998). The method of the review of 30 articles describing 17 intervention studies focused on the following nine elements: (a) relevance of the intervention to the targeted outcome; (b) theoretical components of the intervention; (c) intervention components; (d) complexity, strength, and integrity of the intervention; (e) extraneous factors; (f) adherence to the intervention and retention; (g) reliability and validity of the outcome measures; (h) expected outcomes; and (i) effectiveness of the intervention. The results were that the interventions were relevant and included multiple components, but most interventions lacked an explicit theoretical framework. Adherence to the intervention and retention were problems. Overall, to varying degrees and for those completing the programs, the interventions were effective for increasing physical activity, lowering dietary fat, weight loss, and reducing risk for illness. Twelve “lessons learned” evolved that have practical and research implications. One salient lesson and future priority is to incorporate theory to reveal the intervention content and mechanisms to modify physical activity and dietary behaviors concurrently so that future interventions are more efficacious and efficient. Another lesson revealed the need for more sensitive measures, and examination of ways to improve intervention adherence and retention and prevent relapse.

Identification of Campaign Recruitment Strategies for a Stepped Smoking Cessation Intervention for a College Campus

A rapprochement of the Stepped Approach Model of health care delivery and Ajzens Theory of Planned Behavior was used to identify campaign recruitment strategies for a stepped smoking cessation intervention for a college campus. The study examines outcome expectancies, outcome evaluations, and interest in participating in smoking cessation programs presented in graduated steps of intervention intensity. Telephone surveys were conducted with a probability sample of 191 student smokers. A significant negative trend indicates that the steps are ordered cost-effectively. Scheffé a posteriori tests also reveal that interest in Step 1 (pamphlets and brochures) was significantly higher than interest in any other step, including those representing traditional health care services (i.e., groups and individual treatments). The two strongest predictors of interest in each step were attitudes about participation and control beliefs; normative expectations about program participation discriminated between respondents with high or low interest in Steps 2 through 5. It was concluded that attitudes and control beliefs should be the focus of initial program promotion for college smoking cessation campaigns. Emphasis on attitudes, control beliefs, and especially perceived norms could be helpful in advancing unsuccessful participants to the next more intensive program in a stepped intervention.

Levels of cigarette and alcohol use related to eating-disorder attitudes.

OBJECTIVE To examine levels of cigarette and alcohol use relative to body dissatisfaction and drive for thinness in 206 black and white college women. METHOD Anonymous, paper-and-pencil, self-report questionnaires were administered. RESULTS Frequency of both cigarette and alcohol use were significantly and linearly related to body dissatisfaction and drive for thinness. Regression analyses indicated that negative-affect reduction motivations for use of these substances were more strongly related to eating-disorder attitudes than were levels of use. CONCLUSIONS Cigarette and alcohol use, independent of race and other demographic variables, increased along a continuum with eating-disorder attitudes.

Interest in a Stepped Approach Model (SAM): Identification of Recruitment Strategies for University Alcohol Programs

This study evaluates interest in a stepped approach model (SAM) of service delivery and identifies variables to enhance recruitment to alcohol programs. Subjects were 2,443 college student drinkers (1,420 men and 1,023 women) at a large midwestern university (selected by stratified systematic sampling) who completed a questionnaire on drinking behavior and interest in five intervention steps. Results indicated that there was more interest in interventions that required less time, which supports predictions of SAM. Overall lack of interest peaked at 67% for men and 65% for women and did not change significantly across the last three steps of SAM, which included traditional interventions of group and individual counseling. The data suggest that the stepped approach is more viable than conventional approaches, recruitment is unquestionably an exigent research priority because of the overwhelming lack of interest in alcohol programs, and specific variables that were identified may be important for recruiting particular subgroups.

Longitudinal Change in Physical Activity and Disability in Adults

OBJECTIVES To prospectively examine whether physical activity or change in physical activity increases or decreases the risk of disability later in life. METHODS Tobit regression models were used to examine the effect of physical activity at baseline and change from baseline on disability 10 and 20 years later in 6913 adults. RESULTS Increasing recreational physical activity was associated with reduced risk of disability whereas reducing recreational physical activity increased the risk of disability after 10 years. CONCLUSIONS The analyses reveal a protective effect of sustained physical activity on disability among adults.