Diane Baer Wilson

A preliminary investigation of the predictors of tanning dependence.

OBJECTIVES To investigate possible predictors of tanning dependence including demographic variables, exposure and protective behaviors, and other health-related behaviors. METHODS This study consisted of an online survey of 400 students and other volunteers from a university community. RESULTS Twenty-seven percent of the sample was classified as tanning dependent. Tanning dependence was predicted by ethnicity and skin type, indoor and outdoor tanning and burning, and lower skin protective behaviors, as well as smoking and body mass index. CONCLUSIONS Young adults are at risk for tanning dependence, which can be predicted by specific demographic and behavioral variables.

A Practice-Sponsored Web Site to Help Patients Pursue Healthy Behaviors: An ACORN Study

PURPOSE We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change. METHODS In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction. RESULTS During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians. CONCLUSIONS Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world’s best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.

Patterns of fruit, vegetable, and milk consumption among smoking and nonsmoking female teens

BACKGROUND The increase in teenage smoking, and the fact that concern about body weight is given as a reason for smoking initiation by girls, suggest that food intake may be compromised in female teens who smoke. Daily consumption of a variety of foods is important due to the health-protective constituents they contain. Few studies have documented how smoking and the consumption of fruits, vegetables, and milk may be associated in female teens. METHODS This study examined the relationship of smoking and the consumption of fruit, fruit juice, vegetables, and milk in ninth- to twelfth-grade Caucasian (n=2797), African-American (n=2196), and Hispanic (n=2052) female teens. Data from the Youth Behavior Risk Survey (1999) were analyzed with SUDAAN software, using logistic regression models. RESULTS Smoking was significantly associated with decreased odds of consuming milk at 0.74 (95% confidence interval [CI], 0.55-0.98); fruit, 0.70 (95% CI, 0.54-0.92); fruit juice, 0.74 (95% CI, 0.56-0.98); and vegetables, 0.75 (95% CI, 0.63-0.89) among Caucasian female teens, and with decreased odds of consuming fruit juice among Hispanic female teens at 0.59 (95% CI, 0.40-0.89). For each significant food variable, a dose-response relationship was detected with significantly more females consuming each food at lower smoking levels and significantly fewer doing so at the highest level (p<0.05). By contrast, African-American female teen smokers tended to consume higher levels of the specified food/beverages than nonsmokers, but this relationship was not statistically significant. IMPLICATIONS This study establishes a smoking/food intake interaction for the specific foods tested, in an adolescent female population. Compromising the intake of healthy foods and their protective nutrients leaves young women more vulnerable to the serious health consequences of smoking. These results underscore the need for young women to be educated on the importance of eating maximum servings of fruits and vegetables and dairy products, such as milk, particularly if they smoke or are at risk for smoking initiation. The study also underscores the need to culturally tailor programs according to differences in smoking initiation and eating/dieting behaviors.

Patient Costs As a Barrier to Intensive Health Behavior Counseling

BACKGROUND Although intensive health behavior counseling has been demonstrated to help patients lose weight and quit smoking, many payers offer limited coverage for such counseling. PURPOSE This mixed-methods case study examined how coverage affected utilization of an electronic linkage system (eLinkS) to help adult patients obtain intensive health behavior counseling, provided through a collaboration of primary care practices and community programs. METHODS Grant support enabled patients to obtain counseling at no cost, but funds were exhausted within 5 weeks as a result of an overwhelming response. To study the influence of cost as a barrier, referrals were resumed for an additional 3 weeks, but patients were required to pay for them. Use of eLinkS, level of clinician counseling and referrals, and patient interest in referrals were measured using electronic medical record data and patient and clinician interviews. RESULTS When counseling was free, approximately one in five patients with an unhealthy behavior and an eLinkS prompt was referred for intensive counseling. However, when patient charges were instituted, referrals decreased by 97% (from 21.8% to 0.7%, p<0.001); clinicians asked fewer patients about health behaviors (37% vs 29%, p<0.001); clinicians offered fewer patients referrals (29% vs 6%, p<0.001); and patients were less interested in accepting referrals (76% vs 14%, p<0.001). In interviews, patients and clinicians cited cost as a major barrier. CONCLUSIONS Coverage for intensive health behavior counseling is important to utilization, particularly for interventions that involve clinician-community partnerships. The potential public health benefits of such collaborations to reduce unhealthy behaviors justify the elimination of financial barriers (e.g., copayments) by payers.

The impact of family history of breast cancer and cancer death on women's mammography practices and beliefs

Purpose: To summarize the impact of a family history of breast cancer on mammography practices and beliefs.Method: Survey data concerning breast health practices and beliefs were utilized for a cross-sectional analysis. Participants were 899 racially diverse nonpregnant women 40 years and older without breast cancer. The impact of various aspects of cancer family history on mammography, perceived barriers to and benefits of screening, and perceived breast cancer risk was assessed.Results: More women with a first-degree relative with breast cancer reported a mammogram within the past year and rated their breast cancer risk higher. Death of a first-degree relative impacted the belief that breast cancer can be cured with early detection. Degree of relatedness of affected relative impacted mammography practice and risk perceptions.Conclusion: Family history of breast cancer impacted mammography adherence, beliefs about outcomes with early detection, and risk perceptions. Breast cancer death in a family may be a better predictor of beliefs about breast cancer detection and cure than family history of cancer alone. These findings have implications for how screening recommendations and risk information are communicated to patients with different familial cancer experiences.

Fruit and vegetable intake among rural youth following a school-based randomized controlled trial

OBJECTIVE We implemented a theory-based randomized controlled trial (Living Free of Tobacco, Plus (LIFT+) in ten rural middle schools and assessed impact on tobacco use and fruit/vegetable (F/V) intake in 2008-2010. Data on F/V intake at baseline, immediate post intervention, and 1-year follow-up are presented. METHODS Schools were randomized to intervention or control groups. Goal setting, peer leaders, and class workshops with parent involvement, were intervention features; community partners were supportive. Seventh graders filled out surveys on health behaviors, psycho-social variables, and demographic characteristics. Adjusted models comparing intervention and control conditions were analyzed. RESULTS Sample (n=1119) was 48.5% female, 50% White, with a mean age of 12.7 years. Mean F/V servings were significantly higher in intervention schools at immediate post (3.19 servings) and at 1-year (3.02 servings) compared to controls (2.90, 2.69 respectively). Knowledge of 5-a-day recommendation was significantly higher in intervention schools at immediate post test (75.0%) versus controls (53.8%) but not at 1-year follow-up. CONCLUSIONS Intervention schools reported significantly higher mean F/V servings at post intervention and 1-year, and for knowledge of F/V recommendations at immediate post compared to controls. Higher levels of parent and community involvement may further increase F/V intake in future interventions. ClinicalTrials.gov Identifier: NCT01412697.

Dietary intake in a randomized-controlled pilot of NOURISH: A parent intervention for overweight children

OBJECTIVE NOURISH is a community-based treatment program for parents of overweight and obese children (ages 6-11, BMI ≥ 85 th percentile). This study examined the impact of Nourishing Our Understanding of Role modeling to Improve Support and Health on child and parent dietary intake, secondary trial outcomes. METHODS In Virginia from 2008 to 2009, this randomized controlled pilot was implemented and dietary assessment of parents and children conducted at baseline, post-test, and 6-month follow-up. Parents (85% female, 62% African American, mean BMI=34.1 ± 9.1) were randomized into intervention (n=46) or control (n=50) groups. Childrens (mean age=8.6 ± 1.5) mean Body Mass Index percentile was 98.1 ± 2.6. Parents completed 24-hour dietary records for themselves and their child(ren). Repeated measures analyses assessed treatment effects over time. T-tests evaluated within-group changes from baseline to post-test and to follow-up, using a modified intent-to-treat approach. RESULTS Both groups reported significant dietary changes, with few treatment effects found. For parents in NOURISH, significant improvements were found in intakes of total kilocalories/day, grams/day of carbohydrates and sugar, and percent calories from protein (p<0.05). Among control group children, significant improvements in total kilocalories/day and grams/day of carbohydrates and sugar were found (p<0.05). CONCLUSIONS Among parents who self-select into a childhood obesity program, minimal intervention can elicit short-term dietary changes comparable to those of a structured intervention.

Patient weight counseling choices and outcomes following a primary care and community collaborative intervention.

OBJECTIVE Obesity has become a public health epidemic in adults and children. Clinician practices need new models to effectively address overweight in patients, yet, practices lack time and resources. We tested a clinician-delivered intervention that utilized community resources for in-depth counseling for unhealthy behaviors including overweight. METHODS Eligible patients in nine primary care practices were identified using an electronic linkage system (eLinkS) which also automated patient referrals to group (Weight Watchers), telephone counseling (TC), or usual care. Pre/post-survey data were used to assess factors related to counseling choices as well as changes in BMI (kg/m(2)) and weight-related behaviors using descriptive statistics, unadjusted, and adjusted statistical analyses. RESULTS Study sample (n=146) was 70% female with a mean age of 57 years. More patients (57%) selected WW, followed by usual care (27%) or TC (16%). Age, gender, clinician recommendation, and counseling program characteristics were influential in counseling selections. Weight Watchers participants and those in TC, reported statistically significant weight loss, WW participants also reported significant increases in fruit/vegetable intake; after 4 months compared with usual care. CONCLUSIONS This practice-based intervention utilizing community counseling referrals was associated with positive health behavior change. PRACTICE IMPLICATIONS Identifying influential factors related to patient weight counseling choices may help guide referrals to community programs.

Rural adolescent attitudes toward smoking and weight loss : Relationship to smoking status

Perceptions that smoking contributes to weight loss are widespread among youth. We examined the association between weight loss and smoking to determine whether supportive attitudes were associated with smoking status and whether this is a particular problem in rural areas. High school students (N=730) completed a survey assessing smoking-related characteristics and behaviors. Attitudes assessed included perceptions of whether weight concerns were the reasons others smoke and personal beliefs about tobaccos effect on weight gain. Smoking status was categorized as never (44%), experimental (42%), and current (14%). Multinomial logistic regressions investigated relationships between attitudes and smoking, adjusting for weight goals, gender, ethnicity, parent/peer smoking, and body mass index. Both attitudinal measures were associated with smoking (p< .05). Nonsmokers and experimental smokers were more likely than current smokers to believe that people smoke to lose weight. Although current smokers were less likely to report that others smoke for weight control, they believed they would gain weight if they quit. Conversely, nonsmokers and experimental smokers were less likely to believe they would gain weight if they do not smoke compared with current smokers. Thus personal attitudes differ from attitudes toward others with respect to weight loss and smoking. Moreover, endorsement of these attitudes can reliably distinguish current versus experimental smokers and may help better clarify the transition to current smoker. Because weight concerns are a significant factor in youth smoking, these issues should be included in intervention efforts, particularly in rural communities where smoking rates are higher and age at initiation is earlier.

Parental smoking, closeness to parents, and youth smoking.

OBJECTIVES To examine parent closeness and its effect in predicting youth smoking when 0, 1, or 2 parents smoked. METHODS Youth and parent smoking, closeness to parents, family structure, and gender and ethnicity among middle (n=17,468) and high school (n=5457) students were measured using a questionnaire. RESULTS Number of parents smoking incrementally moderated the protective effect of all 4 measures of parent closeness, in predicting youth smoking. CONCLUSIONS Addressing parent smoking and strengthening family relationships need significantly greater emphasis in interventions to further reduce youth smoking.