Hildemar Dos Santos

Body mass index gain between ages 20 and 40 years and lifestyle characteristics of men at ages 40-60 years: the Adventist Health Study-2.

BACKGROUND Obesity increases risk of premature disease, and may be associated with unfavorable lifestyle changes that add to risk. This study analyzed the association of midlife BMI change with current lifestyle patterns among multiethnic men. METHODS Men aged 40-60 years (n=9864) retrospectively reported body weight between ages 20-40 years and current dietary, TV, physical activity and sleep practices in the Adventist Health Study II, a study of church-goers in the US and Canada. In multivariate logistic regression analysis, odds ratios for BMI gain were calculated for each lifestyle practice controlling for sociodemographic and other lifestyle factors and current BMI. RESULTS Men with median or higher BMI gain (2.79 kg/m(2)) between ages 20-40 years were more likely to consume a non-vegetarian diet, and engage in excessive TV watching and little physical activity and had a shorter sleep duration compared to men with BMI gain below the median (all p<0.001). In multivariate logistic analysis current BMI was significantly associated with all lifestyle factors (all p≤0.005). BMI gain was associated with lower odds of vegetarian diet (odds ratio [OR] 0.939; 95% confidence interval [CI] 0.921-0.957) and of physical activity ≥150 min/week (OR 0.979, 95% CI 0.960-0.999). CONCLUSIONS These findings imply that diet and less physical activity are associated with both gained and attained BMI, while inactivity (TV watching) and short sleep duration correlated only with attained BMI. Unhealthy lifestyle may add risk to that associated with BMI. Longitudinal and intervention studies are needed to infer causal relationships.

Exercise Video Games and Exercise Self-Efficacy in Children.

The aim of this article was to investigate the use of exergaming in promoting exercise behavior among children and to examine the impact of the intervention on participants’ exercise self-efficacy, in addition to assessing physiological changes. A sample of 55 children enrolled in the Family Fit program, where participants were categorized into 2 groups: healthy weight and overweight. Measures were taken at baseline, after the 7-week program, at the 12-week follow-up, and at the 24-month follow-up. Positive changes in exercise self-efficacy were significant for the overweight group, while the healthy weight group maintained their exercise self-efficacy. At the 24-month follow-up, 97% children reported being interested in participating in a future fitness program, and 96% children who did not play sports before the intervention started practicing sports. Exercise self-efficacy is a predictor of physical activity, and incorporating exergaming in a structured program may lead to increased self-efficacy in participants.

Self‐reported exercise and bone mineral density in prostate cancer patients receiving androgen deprivation therapy

Purpose: Men with prostate cancer receiving androgen deprivation therapy (ADT) are at increased risk for decreased bone mineral density (BMD). This study evaluates the relationship between self‐reported daily activity, endurance and resistance exercise, and BMD measured by dual‐energy x‐ray absorptiometry (DEXA) in prostate cancer patients receiving ADT. Data sources: We recruited 96 men treated with ADT for ≥9 months from urology and cancer practices. The Canadian Fitness Survey assessed daily activity and exercise. Data on demographic and lifestyle characteristics and calcium and vitamin D supplementation were collected. Blood was collected for analysis of 25‐OH vitamin D. A DEXA scan was performed. Conclusions: A positive association between endurance exercise and DEXA T‐scores of the hip was shown. Regression analysis showed endurance exercise of medium to heavy intensity (measured as energy expenditure in MET‐hours/week) was associated with T‐scores of the hip (&bgr; = 0.048; 95% CI 0.003, 0.112; p = .040) but not with spinal T‐scores after controlling for age, body mass index, and alcohol use. Implications for practice: Findings are cross‐sectional, but if confirmed in prospective studies suggest that increased endurance exercise is a practical measure nurse practitioners can institute to prevent low bone density in the hip of men treated with ADT.

Health Beliefs About Tobacco With Betel Nut Use Among Adults in Yap, Micronesia.

Tobacco use is high among Pacific Islanders in general and little tobacco research has been done in Yap, Micronesia. This study aimed to explore perceptions of tobacco use coupled with chewing of betel (areca) nut among adults in Yap using self-administered questionnaires based on the health belief model. A Likert scale (ranging from strongly disagree to strongly agree or very unlikely to very likely) was used to measure susceptibility, severity, benefits, barriers, cues to action, and self-efficacy among individuals aged 18 and older. Older adults felt quitting tobacco or betel nut use would be significantly more difficult because of social reasons and withdrawal problems. Most participants felt susceptible to tobacco-related diseases. These findings possibly indicate a receptive attitude toward any future tobacco use prevention and intervention program. Older Yapese population would need to be especially targeted. Health promotion programs should target smoking behaviors and risk reduction.

Abstract C85: Community-based participatory research leads to sustainable lifestyle intervention program for reducing breast cancer risk among African American and Latina women

Minority women are underrepresented in clinical research, which impedes progress in understanding and eliminating health disparities. Reducing health disparities is an important goal of public health community. Recent data suggests that community-based participatory research (CBPR) which systematically involves the affected communities in each stage of the research process-inception, planning, recruitment, conduct and education is the key to reducing health disparities. Between 2001 and 2005 approximately 10,000 invasive and 2,000 in situ breast cancer cases were reported in Region 5 of the San Bernardino County women in California. Although data reveals that the age adjusted incidence rate of 23.7 for in situ breast cancer cases in the Region 5 population is lower than the state-wide rate of 27.3, the number of in situ cases in the area rose from 9.6 in 1988 to 24.8 in 2007. Obesity rates for African American (AA) and Latina adults in the San Bernardino County are 34%. The emergence of the obesity epidemic worldwide has been associated with increases in metabolic syndrome, breast cancer, and type 2 diabetes in the industrialized countries. The proposed pilot study used a CBPR method to study women9s perceptions, beliefs and attitudes towards participating in a clinical breast cancer study that involved blood. Methods: A community-based participatory mixed-methods approach, including a 6-month lifestyle intervention education program was employed. Participants were recruited using purposive convenience sampling that evaluated educational program designed to increase women9s knowledge of positive attitudes and participation in breast cancer clinical studies and simple changes in lifestyle that result in reduced risk for breast cancer. To evaluate the effectiveness of the educational intervention, we used knowledge, attitudes, behavior, and perception-based questionnaire, and in-depth interviews to assess changes before and after the educational experience. Results: Fifty eight women that included 36 African American and 22 Latina women participated in the educational program, out of which twenty five women were recruited into the lifestyle intervention program that required providing blood to test for metabolic syndrome and risk for breast cancer. All the women in the intervention study were willing to provide blood for the study. Seventy six percent of the women in the lifestyle intervention program were either obese or experienced metabolic syndrome. At the end of six months, 78% of the women who participated in the study reduced their body fat by 2% change, by reducing dietary fat consumption. Approximately 93% of the women increased servings of fruits and vegetables in their diet and engaged in some form of exercise after their enrollment into the study. This program is currently sustained by community support groups, after the end of the grant. The project director meets with the women once a month and monitors their life style changes. Conclusion: Community-based participatory research projects that engage community partners through the entire process of research planning and conduct may result in effective sustainable projects that will result in resilient communities. Funding supported by Kaiser Permanente Fontana Community Benefit Grant. Citation Format: Padma Pauline Tadi Uppala, Padma Pauline Tadi Uppala, Loistine Herndon, Hildemar Dos Santos, Amanda Dupre, Persila Mohammadnia, Maheswari Senthil. Community-based participatory research leads to sustainable lifestyle intervention program for reducing breast cancer risk among African American and Latina women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C85. doi:10.1158/1538-7755.DISP13-C85

The effect of non-exercise activity thermogenesis on subjects with metabolic syndrome – a proof of concept study in Qatar

Metabolic syndrome is a cluster of metabolic abnormalities that increases the risk of cardiovascular disease and type 2 diabetes. Total human energy expenditure is divided into three major components; resting metabolic rate, thermic effect of food, and activity thermogenesis which is divided into exercise and non exercise activity thermogenesis (NEAT). In this study, NEAT was used as a lifestyle intervention on subjects with metabolic syndrome. 200 eligible patients from the Diabetes and Endocrinology Department at Hamad Medical Hospital in Doha, Qatar were assigned to an intervention (n = 100) or control (n = 100) group and followed for one year. The intervention group was advised to practice NEAT enhancing activities, while the control group was not advised about NEAT. Measurements of waist circumference, weight, BMI, blood pressure, glucose and lipid profile were assessed at baseline, six months and 1 year. After 1 year 52 intervention and 55 control subjects completed the study. The results revealed no statistically significant differences in metabolic syndrome components between the two randomized groups. The amount of recommended NEAT activity appears to have been too small to influence study outcomes. Future studies in similar populations may need to consider the high dropout rate, and use of incentives or other interventions to increase compliance and retention.

The use of planned behavior theory in predicting cigarette smoking among Waterpipe smokers

AbstractsBackgroundWaterpipe and cigarette smoking have been found to be associated with each other as cigarette smokers were more likely to be waterpipe users than non-cigarette smokers. Also, waterpipe smokers were likely to be former daily cigarette users. The aim of this study is to examine the likelihood of waterpipe use leading to cigarette use among current waterpipe users using theory of planned behavior.MethodsFour hundred six current waterpipe smokers who initially had started tobacco use with the waterpipe were recruited from 15 waterpipe lounges in 2015. From a total of 70 waterpipe lounges in Riyadh, the 15 waterpipe lounges were selected randomly and participants were also selected randomly inside each waterpipe lounge based on the table or section number. The survey was developed using the Qualtrics Online Survey Software and participants completed a survey using iPad tablets.ResultsCigarette smoking and intention to smoke cigarettes were predicted by attitude and perceived behavioral control. There was no direct effect of subjective norm on the cigarette use behavior, yet subjective norm had a statistically significant indirect effect on intentions through attitude and perceived behavioral control.ConclusionsThe findings of this study could be useful in prevention/intervention programs aimed at reducing tobacco smoking behaviors among waterpipe users. Intervention programs might be directed at the attitude and perceived behavioral control by targeting underlying behavioral and control beliefs. The theory of planned behavior provided solid explanations of intention to use cigarettes among waterpipe smokers.

Public Policy and Environmental Supports for Healthy Eating

The epidemic of obesity with its consequent comorbidities such as diabetes, hypertension, and Cardiovascular disease (CVD) is still on a rising trend in the country and the world. CVD is still the main cause of death in the United States (http://www.cdc.gov/obesity/data/adult/html) and in the world (http://www.who.int/mediacentre/factsheets/fs310/en/) [4, 12]. The two main factors responsible for CVD are diet and exercise. An unhealthy high-calorie diet and lack of exercise have been considered the cause of obesity, which is a risk factor for CVD. For years, these two factors have been recognized and appropriately battled to revert the trend of obesity, CVD, and other chronic diseases. However, it seems that those current strategies are not sufficient to deter the epidemic. There is a need for more changes in the community and in the society, changes that support and enable people, adults and children, to perform the behaviors of eating healthy and exercising. Diet and exercise are still the culprits, but there is a need for policies and supporting activities in the community to counteract these chronic diseases that are killing Americans and humans everywhere.

An examination of ecological predictors of health literacy in black college students

ABSTRACT Objective: Health literacy is a determinant of health, but disparities in health literacy persist. This study examined the influence of ecological factors on college students’ health literacy. Participants: During January 2016 a nonrandom sample of black undergraduate students (n = 298) aged 18–24 were recruited from enrollment lists at two urban universities in the Southeastern United States. Methods: Information on health literacy as well as numerous intrapersonal, social, and cultural-environment factors was obtained using an electronic questionnaire and then statistically modeled. Results: Ecological factors accounted for 28.7% of the variance in health literacy. In particular, reappraisal (B = 0.323, p < .001), suppression (B = −0.289, p < .001), campus health education (B = 0.192, p < .05), campus tobacco culture (B = −0.174, p < .05), and perceived norms (B = −0.153, p < .05) directly predicted health literacy. Conclusions: Although intrapersonal factors influence health literacy, the sociocultural environment of college can also foster or hinder college students’ health literacy.

Determinants of vitamin D levels in men receiving androgen deprivation therapy for prostate cancer

Purpose: Studies found an association between decreased 25‐OH vitamin D blood level and prostate cancer progression. Vitamin D supplementation is controversial and dosage recommendations inconsistent. This study identified factors associated with 25‐OH vitamin D levels and whether vitamin D supplementation with 800 IU/day raised vitamin D levels in prostate cancer patients receiving androgen deprivation therapy (ADT). Data sources: We recruited 108 men treated with ADT for ≥9 months from eight cancer and urology practices. Sections of the NHANES 2005–2006 questionnaire and Canadian Fitness Survey were completed identifying age, ethnicity, length of ADT use, calcium supplementation ≥1000 IU mg/day, body mass index, exercise, alcohol and tobacco use, and vitamin D supplementation ≥800 IU/daily. Blood was collected for 25‐OH vitamin D analysis. Conclusions: The majority of men (66%) had blood levels of 25‐OH vitamin D <32 ng/mL. Regression analysis showed vitamin D supplementation (&bgr; = 6.556, CI 1.463, 11.650; p = .012) and African American ethnicity (&bgr; = −7.816, CI −12.996, −2.635; p = .003) is associated with 25‐OH vitamin D level after controlling age and tobacco use. Practice implications: Findings support current recommendations for supplementation with ≥800 IU vitamin D/day for men receiving ADT. Nurse practitioners caring for prostate cancer patients receiving ADT should include vitamin D monitoring and supplementation.