James R. Hussey

Relationship between number of sexual intercourse partners and selected health risk behaviors among public high school adolescents.

PURPOSE To examine the relationship between number of sexual partners and selected health risk behaviors in a statewide sample of public high school students. METHODS The Centers for Disease Control and Prevention Youth Risk Behavior Survey was used to secure usable sexual risk-taking, substance use, and violence/aggression data from 3805 respondents. Because simple polychotomous logistic regression analysis revealed a significant Race x Gender interaction, subsequent multivariate models were constructed separately for each race-gender group. Odds ratios and 95% confidence intervals was calculated from polychotomous logistic regression models for number of sexual intercourse partners and their potential risk behavior correlates. RESULTS An increased number of sexual intercourse partners were correlated with a cluster of risk behaviors that place adolescents at risk for unintended pregnancy, human immunodeficiency virus/acquired immunodeficiency syndrome, and other sexually transmitted infections. For Black females, alcohol, tobacco, marijuana use, and dating violence behaviors were the strongest predictors of an increased number of sexual partners; white females had similar predictors with the addition of physical fighting. For white males, alcohol, tobacco, marijuana use, physical fighting, carrying weapons, and dating violence were the strongest predictors of an increased number of sexual intercourse partners. Black males had similar predictors with the addition of binge alcohol use. CONCLUSION Prevention of adolescent sexual and other health risk behaviors calls for creative approaches in school and community settings and will require long-term intervention strategies focused on adolescent behavior changes and environmental modifications.

The relationship between diet, activity, and other factors, and postpartum weight change by race.

Objective To identify the impact of dietary intake and activity level on postpartum weight change. Methods White (n = 121) and black (n = 224) women, 7–12 months postpartum, participating in the Special Supplemental Feeding Program for Women, Infants, and Children were assessed for dietary intake, activity level, body weight, and other maternal characteristics. Results For both black and white women, the most important variables in predicting postpartum weight loss were pre-pregnancy weight, gestational weight gain, parity, and prenatal exercise. After these factors were controlled, race predicted that black women retained 6.4 lb more than white women. These results may be due to the finding that black women reported significantly higher mean energy intake (2039 versus 1552 kcal, P < .001), higher percent fat in diet (41 versus 38%, P < .001), and significantly lower amounts of prenatal and postpartum activity. Conclusion Higher energy intake and lower activity levels in black postpartum mothers compared with white mothers may contribute to the significantly higher rates of obesity found in black mothers. This study suggests the need for intervention strategies in the prenatal and postpartum periods to help those at risk of retaining weight gained during pregnancy.

Hyperbaric Oxygen Treatment of Chronic Refractory Radiation Proctitis: A Randomized and Controlled Double-Blind Crossover Trial With Long-Term Follow-Up

PURPOSE Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced injury to normal tissues. We conducted a randomized, controlled, double-blind crossover trial with long-term follow-up to evaluate the effectiveness of hyperbaric oxygen for refractory radiation proctitis. METHODS AND MATERIALS Patients with refractory radiation proctitis were randomized to hyperbaric oxygen at 2.0 atmospheres absolute (Group 1) or air at 1.1 atmospheres absolute (Group 2). The sham patients were subsequently crossed to Group 1. All patients were re-evaluated by an investigator who was unaware of the treatment allocation at 3 and 6 months and Years 1-5. The primary outcome measures were the late effects normal tissue-subjective, objective, management, analytic (SOMA-LENT) score and standardized clinical assessment. The secondary outcome was the change in quality of life. RESULTS Of 226 patients assessed, 150 were entered in the study and 120 were evaluable. After the initial allocation, the mean SOMA-LENT score improved in both groups. For Group 1, the mean was lower (p = 0.0150) and the amount of improvement nearly twice as great (5.00 vs. 2.61, p = 0.0019). Similarly, Group 1 had a greater portion of responders per clinical assessment than did Group 2 (88.9% vs. 62.5%, respectively; p = 0.0009). Significance improved when the data were analyzed from an intention to treat perspective (p = 0.0006). Group 1 had a better result in the quality of life bowel bother subscale. These differences were abolished after the crossover. CONCLUSION Hyperbaric oxygen therapy significantly improved the healing responses in patients with refractory radiation proctitis, generating an absolute risk reduction of 32% (number needed to treat of 3) between the groups after the initial allocation. Other medical management requirements were discontinued, and advanced interventions were largely avoided. Enhanced bowel-specific quality of life resulted.

Factors of Fruit and Vegetable Intake by Race, Gender, and Age among Young Adolescents

OBJECTIVE To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake. DESIGN Self-report questionnaires administered to a convenience sample of middle school students during regular classes. PARTICIPANTS Black and white adolescents, 11 to 15 years of age (N = 736). VARIABLES MEASURED Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics. ANALYSIS Chi-square, general linear models, and Poisson and linear regressions as appropriate. RESULTS Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice. CONCLUSIONS AND IMPLICATIONS Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding

OBJECTIVE: We investigated the effect of maternity leave length and time of first return to work on breastfeeding. METHODS: Data were from the Early Childhood Longitudinal Study–Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview and worked in the 12 months before delivery (N = 6150), we classified the length of total maternity leave (weeks) as 1 to 6, 7 to 12, ≥13, and did not take; paid maternity leave (weeks) as 0, 1 to 6, ≥7, and did not take; and time of return to work postpartum (weeks) as 1 to 6, 7 to 12, ≥13, and not yet returned. Analyses included χ2 tests and multiple logistic regressions. RESULTS: In our study population, 69.4% initiated breastfeeding with positive variation by both total and paid maternity leave length, and time of return to work. In adjusted analyses, neither total nor paid maternity leave length had any impact on breastfeeding initiation or duration. Compared with those returning to work within 1 to 6 weeks, women who had not yet returned to work had a greater odds of initiating breastfeeding (odds ratio [OR]: 1.46 [1.08–1.97]; risk ratios [RR]: 1.13 [1.03–1.22]), continuing any breastfeeding beyond 6 months (OR: 1.41 [0.87–2.27]; RR: 1.25 [0.91–1.61]), and predominant breastfeeding beyond 3 months (OR: 2.01 [1.06–3.80]; RR: 1.70 [1.05–2.53]). Women who returned to work at or after 13 weeks postpartum had higher odds of predominantly breastfeeding beyond 3 months (OR: 2.54 [1.51–4.27]; RR: 1.99 [1.38–2.69]). CONCLUSION: If new mothers delay their time of return to work, then duration of breastfeeding among US mothers may lengthen.

Soul Food Light : Culturally Competent Diabetes Education

Purpose The purpose of this study was to test effects of a culturally competent, dietary self-management intervention on physiological outcomes and dietary behaviors for African Americans with type 2 diabetes. Methods A longitudinal experimental study was conducted in rural South Carolina with a sample of 97 adult African Americans with type 2 diabetes who were randomly assigned to either usual care or the intervention. The intervention consisted of 4 weekly classes in low-fat dietary strategies, 5 monthly peer-professional group discussions, and weekly telephone follow-up. The culturally competent approach reflected the ethnic beliefs, values, customs, food preferences, language, learning methods, and health care practices of southern African Americans. Results Body mass index and dietary fat behaviors were significantly lowered in the experimental group. At 6 months, weight decreased 1.8 kg (4 lb) for the experimental group and increased 1.9 kg (4.2 lb) for the control group, a net difference of 3.7 kg (8.2 lb). The experimental group reduced high-fat dietary habits to moderate while high-fat dietary habits of the control group remained essentially unchanged. A trend in reduction of A1C and lipids was observed. Conclusions Results suggest the effectiveness of a culturally competent dietary self-management intervention in improving health outcomes for southern African Americans, especially those at risk due to high-fat diets and body mass index ≥ 35 kg/mm2. Given the burgeoning problem of obesity in South Carolina and the nation, the time has come to focus on aggressive weight management. Diabetes educators are in pivotal positions to assume leadership in achieving this goal for vulnerable, rural populations.

Maternal Social Support and Neighborhood Income Inequality as Predictors of Low Birth Weight and Preterm Birth Outcome Disparities: Analysis of South Carolina Pregnancy Risk Assessment and Monitoring System Survey, 2000–2003

Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000–2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14–3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.

Cardiorespiratory Fitness as a Predictor of Dementia Mortality in Men and Women

UNLABELLED There is evidence that physical activity may reduce the risk of developing Alzheimer disease and dementia. However, few reports have examined the physical activity-dementia association with objective measures of physical activity. Cardiorespiratory fitness (hereafter called fitness) is an objective reproducible measure of recent physical activity habits. PURPOSE We sought to determine whether fitness is associated with lower risk for dementia mortality in women and men. METHODS We followed 14,811 women and 45,078 men, age 20-88 yr at baseline, for an average of 17 yr. All participants completed a preventive health examination at the Cooper Clinic in Dallas, TX, during 1970-2001. Fitness was measured with a maximal treadmill exercise test, with results expressed in maximal METs. The National Death Index identified deaths through 2003. Cox proportional hazards models were used to examine the association between baseline fitness and dementia mortality, adjusting for age, sex, examination year, body mass index, smoking, alcohol use, abnormal ECGs, and health status. RESULTS There were 164 deaths with dementia listed as the cause during 1,012,125 person-years of exposure. Each 1-MET increase in fitness was associated with a 14% lower adjusted risk of dementia mortality (95% confidence interval (CI) = 6%-22%). With fitness expressed in tertiles, adjusted hazard ratios (HRs) for those in the middle- and high-fitness groups suggest their risk of dementia mortality was less than half that of those in the lowest fitness group (HR = 0.44, CI = 0.26-0.74 and HR = 0.49, CI = 0.26-0.90, respectively). CONCLUSIONS Greater fitness was associated with lower risk of mortality from dementia in a large cohort of men and women.

Muscular Strength and Incident Hypertension in Normotensive and Prehypertensive Men

UNLABELLED The protective effects of cardiorespiratory fitness (CRF) on hypertension (HTN) are well known; however, the association between muscular strength and incidence of HTN has yet to be examined. PURPOSE This study evaluated the strength-HTN association with and without accounting for CRF. METHODS Participants were 4147 men (age = 20-82 yr) in the Aerobics Center Longitudinal Study for whom an age-specific composite muscular strength score was computed from measures of a one-repetition maximal leg and a one-repetition maximal bench press. CRF was quantified by maximal treadmill exercise test time in minutes. Cox proportional hazards regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals of incident HTN events according to exposure categories. RESULTS During a mean follow-up of 19 yr, there were 503 incident HTN cases. Multivariable-adjusted (excluding CRF) HR of HTN in normotensive men comparing middle- and high-strength thirds to the lowest third were not significant at 1.17 and 0.84, respectively. Multivariable-adjusted (excluding CRF) HR of HTN in baseline prehypertensive men comparing middle- and high-strength thirds to the lowest third were significant at 0.73 and 0.72 (P = 0.01 each), respectively. The association between muscular strength and incidence of HTN in baseline prehypertensive men was no longer significant after control for CRF (P = 0.26). CONCLUSIONS The study indicated that middle and high levels of muscular strength were associated with a reduced risk of HTN in prehypertensive men only. However, this relationship was no longer significant after controlling for CRF.

Effects of Feldenkrais Exercises on Balance, Mobility, Balance Confidence, and Gait Performance in Community-Dwelling Adults Age 65 and Older

BACKGROUND Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls. OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults. METHODS Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted. RESULTS After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067). CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.