Diana W. Stewart

Associations Between Health Literacy and Established Predictors of Smoking Cessation

OBJECTIVES We examined associations between health literacy and predictors of smoking cessation among 402 low-socioeconomic status (SES), racially/ethnically diverse smokers. METHODS Data were collected as part of a larger study evaluating smoking health risk messages. We conducted multiple linear regression analyses to examine relations between health literacy and predictors of smoking cessation (i.e., nicotine dependence, smoking outcome expectancies, smoking risk perceptions and knowledge, self-efficacy, intentions to quit or reduce smoking). RESULTS Lower health literacy was associated with higher nicotine dependence, more positive and less negative smoking outcome expectancies, less knowledge about smoking health risks, and lower risk perceptions. Associations remained significant (P < .05) after controlling for demographics and SES-related factors. CONCLUSIONS These results provide the first evidence that low health literacy may serve as a critical and independent risk factor for poor cessation outcomes among low-socioeconomic status, racially/ethnically diverse smokers. Research is needed to investigate potential mechanisms underlying this relationship.

Support needs of overweight African American women for weight loss.

OBJECTIVES To examine social support needs of obese and overweight African American women for weight loss. METHODS Focus groups were conducted with overweight and obese African American women. Data were analyzed using standard grounded theory text analysis. RESULTS Our middle-aged (45.7 years; SD = 12.6) women (N = 66) were interested in receiving support from others focused on the health benefits of weight loss. Behaviors perceived as supportive include co-participating in exercise, providing nutrition education, using positive reinforcements, and avoiding criticism. CONCLUSIONS African American women are interested in a program designed to increase social support for their weight loss.

Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females

Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms of young adult female smokers (n=184) and non-smokers (n=56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p=.03, and the Bulimia Test-Revised, p=.006. In addition, a higher proportion of smokers than non-smokers scored > or = 85 on the Bulimia Test-Revised, p=.05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences were found between smokers and non-smokers on other measures of eating behavior. Overall, findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.

The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border.

BackgroundThe prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border.MethodsThe characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c).ResultsParticipants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c).ConclusionsOverall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.

Unique relationships between facets of mindfulness and eating pathology among female smokers

Female smokers often have higher levels of eating disorder symptoms than non-smokers, and concerns about eating and weight might interfere with smoking cessation. Thus, it is critical to identify factors to promote healthier eating and body image in this population. Initial research suggests that specific aspects of trait mindfulness predict lower body dissatisfaction and eating disorder symptoms among non-smokers. However, these relationships are unknown among smokers. The current study examined associations between facets of trait mindfulness and eating disorder symptoms in 112 college female smokers (83% Caucasian; mean age 20 years, SD=1.69). After controlling for relevant sociodemographic variables, Describing and Nonjudging facets of mindfulness predicted lower bulimic symptoms and body dissatisfaction (ps<.05), while Acting with Awareness predicted lower bulimic and anorexic symptoms, ps<.05. Observing predicted higher anorexic symptoms, p<.05. These results suggest that specific mindfulness facets are related to lower eating disorder symptoms among smokers, whereas other facets are not associated or have a positive relationship with these symptoms. Mindfulness-based interventions focusing on Describing, Nonjudging, and Acting with Awareness may help to reduce eating pathology among female smokers, which could potentially improve smoking cessation rates in this population.

Directive support, nondirective support, and health behaviors in a community sample

Social support is associated with improved psychological functioning, physical health, and health-promoting behaviors. However, research suggests that health outcomes might depend upon the type rather than the amount of support provided to recipients. This study assessed the relationship among nondirective and directive support, and health behaviors (i.e., physical activity, fruit and vegetable intake, alcohol use) in a community sample of 304 adults. Results revealed that nondirective support was related to greater fruit and vegetable intake and lower alcohol use; directive support was not associated with these behaviors. For physical activity, a similar trend emerged, but support variables did not explain any variance above that explained by demographic variables. These findings offer a unique contribution to the literature, as they suggest that certain types of supportive behaviors are important in encouraging positive health behaviors.

The effect of food deprivation on cigarette smoking in females

Food deprivation is associated with increased self-administration of nicotine and other substances in laboratory animals, although little is known about the effects of food deprivation on substance use in humans. A within-subjects design was utilized to test the primary hypotheses that smoking rate and expired carbon monoxide (CO) levels would be greater among 15 female participants following a 24-hour fasting period than when participants were not food-deprived. Food-deprived participants were also expected to endorse greater negative mood, smoking urges, and pleasure from smoking, as well as less positive mood. Analyses indicated that CO levels were significantly greater in the food-deprived condition than in the non-deprived condition (p=.05), although no differences were found in the number of cigarettes smoked during the laboratory session. Participants reported significantly lower Vigor-Activity in the food-deprived condition (p=.02). No differences were found between conditions in urges to smoke or pleasure from smoking. Findings suggest that nicotine intake may increase among females during acute food deprivation.

Race Moderates the Effect of Menthol Cigarette Use on Short-Term Smoking Abstinence

INTRODUCTION The Food and Drug Administration is in the process of reviewing evidence of the impact of mentholated cigarettes on smoking behaviors and smoking cessation in order to determine if these products should be removed from the market. More empirical research is needed to inform those decisions. The goal of this study was to examine associations of menthol cigarette use with biochemically verified continuous short-term smoking abstinence, and potential moderation by race, among adult current smokers enrolled in a cohort study (N = 183; 57.4% female; 48.1% non-Hispanic Black, 51.9% non-Hispanic White). METHODS Continuation ratio logit models, adjusted for age, race, gender, total annual household income, educational level, employment status, and partner status, were used to examine associations of menthol use with smoking abstinence with and without an interaction term for race. RESULTS Menthol cigarette use was not significantly associated with smoking abstinence in the sample as a whole; however, there was a significant interaction of menthol use with race (p = .03). Follow-up analyses stratified by race indicated that among White participants, menthol users had significantly lower odds of maintaining continuous abstinence than nonmenthol users (p = .05). Exploratory analyses suggested that tobacco dependence may lie along the causal pathway and partially explain this effect. CONCLUSIONS White menthol smokers in this sample were at increased risk of smoking relapse relative to White nonmenthol smokers, at least partially due to greater tobacco dependence. Results should be replicated among other treatment-seeking samples with a greater representation of White menthol and Black nonmenthol smokers.

Lifestyle and cancer prevention in women: Knowledge, perceptions, and compliance with recommended guidelines

BACKGROUND Most women in the United States do not meet minimum recommendations for physical activity or fruit/vegetable consumption. Thus, many are overweight/obese and are at increased risk for cancer morbidity and mortality. This study investigated womens perceptions about the importance of physical activity and a healthy diet in preventing cancer, perceptions of engaging in these behaviors, and whether or not the behaviors met cancer prevention recommendations. METHOD A cross-sectional, national, random-digit-dialed telephone survey was conducted with 800 women, ages 18 and older. The response rate was 24.5%. Measures assessed demographics, perceived health status, beliefs about the role of physical activity and diet in cancer prevention, perceived engagement in these behaviors, and actual behaviors. RESULTS Only 9.9% of women who reported eating a healthy diet met minimum fruit and vegetable recommendations; 39.7% of women who reported regular physical activity met the minimum recommendation. Analyses adjusted for demographics indicated that low education was associated with reporting regular physical activity to prevent cancer, yet failing to meet the minimum recommendation (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.82-0.98, p=0.01). Racial/ethnic minority status was marginally significantly associated with reporting eating a healthy diet to prevent cancer, yet failing to consume sufficient fruits and vegetables (OR=2.94, 95% CI: 0.99-8.71, p=0.05). CONCLUSIONS Most women who reported eating a healthy diet and being physically active to prevent cancer failed to meet the minimum cancer prevention recommendations. Furthermore, low socioeconomic status and racial/ethnic minority women may be particularly vulnerable to discrepancies between beliefs and behavior.

Psychometric Properties of a Brief Smoking Consequences Questionnaire for Adults (SCQ-A) Among African American Light Smokers

ABSTRACT Despite a decline in cigarette smoking over the past few decades, rates remain unacceptably high for certain segments of the population, such as urban African Americans (AAs). AA smokers, on average, smoke fewer cigarettes per day than European American samples; however, AA smokers are less likely to achieve abstinence during a quit attempt. Outcome expectancies have previously been association with cessation outcomes, but prior research has not examined expectancies among treatment-seeking AA light smokers. The 33-item Smoking Consequences Questionnaire–Adult (SCQ-A) was evaluated among 751 AA light smokers (i.e., ≤ 10 cigarettes per day) enrolled in a cessation trial. Exploratory factor analyses replicated the original 10-factor solution. Factors were significantly correlated (r = −.06–51, P < .001) and associated with expected demographic, psychosocial, and tobacco-related variables. Results provide initial validation of the SCQ-A among AA light smokers seeking cessation treatment and highlight the association of smoking expectancies with other tobacco-related and psychosocial factors in this sample.