Frank M. Perna

Self-reported and Objectively Measured Activity Related to Biomarkers Using Nhanes

PURPOSE The purpose of this study was to examine the independent associations of self-reported and objectively measured (using accelerometers) moderate to vigorous physical activity (MVPA) with physiological and anthropometric biomarkers in a nationally representative sample of U.S. adults. METHODS Data from the cross-sectional National Health and Nutrition Examination Survey 2003-2006 data were analyzed. Adults 20 yr and older (N=5797) with self-reported PA and 4 d or more of accelerometer data were included in the analyses. Pregnant or lactating women were excluded. Outcomes were blood pressure, body mass index, waist circumference, triceps and subscapular skinfolds, cholesterol, triglyceride, C-reactive protein, homocysteine, and insulin resistance and hyperinsulinemia indices. RESULTS Objectively measured MVPA displayed stronger independent associations with the biomarkers than did self-reported MVPA, even after adjusting for sociodemographic and health factors (adjusted Wald F values=3.9-85.6, P<0.05-0.0001). Self-reported and objectively measured MVPA were independently associated with skinfold measures, HDL, and C-reactive protein when both were included in the model. CONCLUSIONS Objectively measured MVPA displayed stronger associations with physiological and anthropometric biomarkers than self-reported MVPA. However, self-reported and objectively measured MVPA appear to capture distinct aspects of PA that are independently associated with certain biomarkers. Further understanding of the distinct contributions of self-reported and objectively measured PA to health outcomes could help to better identify optimal activity level and pattern.

Behavioral and psychological care in weight loss surgery: best practice update.

The objective of this study is to update evidence‐based best practice guidelines for psychological evaluation and treatment of weight loss surgery (WLS) patients. We performed a systematic search of English‐language literature on WLS and mental health, quality of life, and behavior modification published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. Our literature search identified 17 articles of interest; 13 of the most relevant were reviewed in detail. From these, we developed evidence‐based best practice recommendations on the psychological assessment and treatment of WLS patients. Regular updates of evidence‐based recommendations for best practices in psychological care are required to address the impact of mental health on short‐ and long‐term outcomes after WLS. Key factors in patient safety include comprehensive preoperative evaluation, use of appropriate and reliable evaluation instruments, and the development of short‐ and long‐term treatment plans.

Cognitive behavioral stress management effects on injury and illness among competitive athletes: A randomized clinical trial

Cognitive behavioral stress management (CBSM) has previously been found to reduce fatigue, depression, and cortisol response to heavy exercise training among competitive collegiate athletes and to speed physical and psychological recovery from surgery (1,2). Our study assessed the efficacy of a CBSM program to reduce the frequency of injury and illness among collegiate athletes in a randomized, single-blind, controlled clinical trial. Following assessment of baseline medical history, mood state, stress, cortisol, sleep, alcohol use, and exercise training, collegiate rowers were stratified by gender and competitive level and randomly assigned to either a control group or a CBSM group. Exercise training information and psychosocial assessments were repeated immediately following the intervention period, and health care providers who were blinded to participant assignment recorded the frequency of medical visits and the number of days injured or ill until the end of the season. Athletes randomly assigned to a CBSM group experienced significant reductions in the number of illness and injury days as compared to control group athletes. CBSM participants also had half the number of health service visits as did controls. The data suggest that a time-limited CBSM intervention designed specifically for an athlete population may be an effective prophylactic treatment to reduce the incidence of injury and illness among competitive collegiate athletes.

Weight status among adolescents in states that govern competitive food nutrition content

OBJECTIVES: To determine if state laws regulating nutrition content of foods and beverages sold outside of federal school meal programs (“competitive foods”) are associated with lower adolescent weight gain. METHODS: The Westlaw legal database identified state competitive food laws that were scored by using the Classification of Laws Associated with School Students criteria. States were classified as having strong, weak, or no competitive food laws in 2003 and 2006 based on law strength and comprehensiveness. Objective height and weight data were obtained from 6300 students in 40 states in fifth and eighth grade (2004 and 2007, respectively) within the Early Childhood Longitudinal Study–Kindergarten Class. General linear models estimated the association between baseline state laws (2003) and within-student changes in BMI, overweight status, and obesity status. Fixed-effect models estimated the association between law changes during follow-up (2003–2006) and within-student changes in BMI and weight status. RESULTS: Students exposed to strong laws at baseline gained, on average, 0.25 fewer BMI units (95% confidence interval: −0.54, 0.03) and were less likely to remain overweight or obese over time than students in states with no laws. Students also gained fewer BMI units if exposed to consistently strong laws throughout follow-up (β = −0.44, 95% confidence interval: −0.71, −0.18). Conversely, students exposed to weaker laws in 2006 than 2003 had similar BMI gain as those not exposed in either year. CONCLUSIONS: Laws that regulate competitive food nutrition content may reduce adolescent BMI change if they are comprehensive, contain strong language, and are enacted across grade levels.

From Ideas to Efficacy: The ORBIT Model for Developing Behavioral Treatments for Chronic Diseases

OBJECTIVE Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases. METHOD The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. RESULTS This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases. CONCLUSIONS The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record

Best Practice Updates for Multidisciplinary Care in Weight Loss Surgery

The objective of this study is to update evidence‐based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English‐language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. A total of 150 papers were retrieved from the literature search and 112 were reviewed in detail. We made evidence‐based best practice recommendations from the most recent literature on multidisciplinary care of WLS patients. New recommendations were developed in the areas of patient selection, medical evaluation, and treatment. Regular updates of evidence‐based recommendations for best practices in multidisciplinary care are required to address changes in patient demographics and levels of obesity. Key factors in patient safety include comprehensive preoperative medical evaluation, patient education, appropriate perioperative care, and long‐term follow‐up.

Validation of the flow theory in an on-site whitewater kayaking setting.

The validation of the flow theory in an on-site whitewater setting is examined. A-priori hypotheses emphasized 3 concerns: (1) the relationship between a four channel model of flow and specific levels of flow indicators, (2) differences in the explanatory power of the four channel model and an original model of flow, and (3) the relationship between river difficulty and the frequencies of four channels (flow, anxiety, apathy, and boredom). On-site experiences of 52 whitewater kayakers were assessed with a series of single page questionnaires administered in the Cheat River Canyon in West Virginia. Sampling techniques involved a modification of the Experience Sampling Method using eight measurement intervals of varying levels of river difficulty. Data were analyzed at the level of experience (n = 409). A-priori hypothesis testing, based on the results of statistical analyses (ANOVA, linear regression, and Chi-square test of association), supported the validation of the flow theory. This validation was demonstrated by the significant relationship between a four channel model and subjective experiences, the positivity of experience during a state of flow, the explanatory power of the four channel model, and differences in channel frequencies across river stages. Patterns of results which were contrary to expectation indicate similarities in subjective experiences between flow and anxiety channels, suggesting that whitewater kayakers may have positive experiences even when their abilities are exceeded by the difficulty of the river.

An Empirical Comparison of the Four Channel Flow Model and Adventure Experience Paradigm

The objective of this study was to conduct empirical comparisons between two models of optimal experience within an on-site whitewater kayaking setting using a modification of the Experience Sampling Method. Four concerns are examined: (1) differences in explanatory power between the four channel flow model and the Adventure Experience Paradigm, (2) convergent validity among measures used to determine conditions within these models, (3) differences among measures of perceived challenge and risk between test times of Class I-V river difficulty, and (4) differences among measures of perceived skill and competence between test times of Class I-V river difficulty. Questionnaires were administered in the Cheat River Canyon in West Virginia to 52 whitewater kayakers at eight sites of various levels of river difficulty. Data were analyzed at the experience level, rather than between subjects, using 409 experience sampling observations. Hypothesis testing, performed with statistical analyses (stepwise regression, correlations, and repeated measures ANOVA), suggested that the explanatory powers of the four channel flow model and Adventure Experience Paradigm were similar and indicated support for convergent and ecological validity of measures used to determine conditions within each of the two models.

The association between demographic and behavioral characteristics and sunburn among U.S. adults - National Health Interview Survey, 2010.

OBJECTIVE To examine the association between demographic and behavioral characteristics and sunburn among U.S. adults. METHOD We used 2010 National Health Interview Survey data (N=24,970) to conduct multivariable logistic regressions examining associations with having 1 or more sunburns in the past year and having 4 or more sunburns in the past year. RESULTS Overall, 37.1% of adults experienced sunburn in the past year. The adjusted prevalence of sunburn was particularly common among adults aged 18-29years (52.0%), those who repeatedly burn or freckle after 2weeks in the sun (45.9%), whites (44.3%), indoor tanners (44.1%), those with a family history of melanoma (43.9%), and those who are US-born (39.5%). Physical activity, alcohol consumption, and overweight/obesity were positively associated with sunburn (all P<0.001); sun protection behaviors were not significantly associated with sunburn (P=0.35). Among those who were sunburned in the past year, 12.1% experienced 4 or more sunburns. CONCLUSION Sunburn is common, particularly among younger adults, those with a more sun-sensitive skin type, whites, those with a family history of melanoma, the highly physically active, and indoor tanners. Efforts are needed to facilitate sun-safety during outdoor recreation, improve the consistency of sun protection practices, and prevent sunburn, particularly among these subgroups.

Strategies to Reduce Indoor Tanning: Current Research Gaps and Future Opportunities for Prevention

Exposure to ultraviolet radiation from indoor tanning device use is associated with an increased risk of skin cancer, including risk of malignant melanoma, and is an urgent public health problem. By reducing indoor tanning, future cases of skin cancer could be prevented, along with the associated morbidity, mortality, and healthcare costs. On August 20, 2012, the CDC hosted a meeting to discuss the current body of evidence on strategies to reduce indoor tanning as well as research gaps. Using the Action Model to Achieve Healthy People 2020 Overarching Goals as a framework, the current paper provides highlights on the topics that were discussed, including (1) the state of the evidence on strategies to reduce indoor tanning; (2) the tools necessary to effectively assess, monitor, and evaluate the short- and long-term impact of interventions designed to reduce indoor tanning; and (3) strategies to align efforts at the national, state, and local levels through transdisciplinary collaboration and coordination across multiple sectors. Although many challenges and barriers exist, a coordinated, multilevel, transdisciplinary approach has the potential to reduce indoor tanning and prevent future cases of skin cancer.