James W. Hardin

Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial

BackgroundThe SenseWear™ Armband (SWA) (BodyMedia, Inc. Pittsburgh, PA) is a physical activity and lifestyle monitor that objectively and accurately measures free-living energy balance and sleep and includes software for self-monitoring of daily energy expenditure and energy intake. The real-time feedback of the SWA can improve individual self-monitoring and, therefore, enhance weight loss outcomes.MethodsWe recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 y; body mass index (BMI), 33.3 ± 5.2 kg/m2; 81% women, 32% African-American) from the greater Columbia, South Carolina area. Participants were randomized into 1 of 4 groups, a self-directed weight loss program via an evidence-based weight loss manual (Standard Care, n = 50), a group-based behavioral weight loss program (GWL, n = 49), the armband alone (SWA-alone, n = 49), or the GWL plus the armband (GWL+SWA, n = 49), during the 9-month intervention. The primary outcome was change in body weight and waist circumference. A mixed-model repeated-measures analysis compared change in the intervention groups to the standard care group on weight and waist circumference status after adjusting for age, sex, race, education, energy expenditure, and recruitment wave.ResultsBody weight was available for 62% of participants at 9 months (52% standard care, 70% intervention). There was significant weight loss in all 3 intervention groups (GWL, 1.86 kg, P = 0.05; SWA-alone, 3.55 kg, P = 0.0002; GWL+SWA, 6.59 kg, P < 0.0001) but not in the Standard Care group (0.89 kg, P = 0.39) at month 9. Only the GWL+SWA group achieved significant weight loss at month 9 compared to the Standard Care group (P = 0.04). Significant waist circumference reductions were achieved in all 4 groups at month 9 (Standard Care, 3.49 cm, P = 0.0004; GWL, 2.42 cm, P = 0.008; SWA-alone, 3.59 cm, P < 0.0001; GWL+SWA, 6.77 cm, P < 0.0001), but no intervention group had significantly reduced waist circumference compared to the Standard Care group.ConclusionsContinuous self-monitoring from wearable technology with real-time feedback may be particularly useful to enhance lifestyle changes that promote weight loss in sedentary overweight or obese adults. This strategy, combined with a group-based behavioral intervention, may yield optimal weight loss.Trial RegistrationClinicalTrials.gov: NCT00957008

HIV Discrimination and the Health of Women Living with HIV

ABSTRACT Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African-American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects womens mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.

Prospective study of cardiorespiratory fitness and depressive symptoms in women and men.

Most studies of the relationship between cardiorespiratory fitness (CRF) and depression have been limited to cross-sectional designs. The objective of this study was to follow individuals over time to examine whether those with higher levels of CRF have lower risk of developing depressive symptoms. Participants were 11,258 men and 3085 women enrolled in the Aerobics Center Longitudinal Study in Dallas, TX. All participants completed a maximal treadmill exercise test at baseline (1970-1995) and a follow-up health survey in 1990 and/or 1995. Individuals with a history of a mental disorder, cardiovascular disease, or cancer were excluded. CRF was quantified by exercise test duration, and categorized into age and sex-stratified groups as low (lowest 20%), moderate (middle 40%), or high (upper 40%). Depressive symptoms were assessed using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D). Those who scored 16 or more on the CES-D were considered to have depressive symptoms. After an average of 12 years of follow-up, 282 women and 740 men reported depressive symptoms. After adjusting for age, baseline examination year, and survey response year, the odds of reporting depressive symptoms were 31% lower for men with moderate CRF (odds ratio, OR 0.69; 95% confidence interval, CI 0.56-0.85) and 51% lower for men with high CRF (OR 0.49, CI 0.39-0.60), compared to men with low CRF. Corresponding ORs for women were 0.56 (CI 0.40-0.80) and 0.46 (CI 0.32-0.65). Higher CRF is associated with lower risk of incident depressive symptoms independent of other clinical risk predictors.

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence.

OBJECTIVES We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. METHODS In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. RESULTS Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. CONCLUSIONS Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

Detection of Forced Climate Signals. Part 1: Filter Theory

Abstract This paper considers the construction of a linear smoothing filter for estimation of the forced part of a change in a climatological field such as the surface temperature. The filter is optimal in the sense that it suppresses the natural variability or “noise” relative to the forced part or “signal” to the maximum extent possible. The technique is adapted from standard signal processing theory. The present treatment takes into account the spatial as well as the temporal variability of both the signal and the noise. In this paper we take the signals waveform in space-time to be a given deterministic field in space and lime. Formulation of the expression for the minimum mean-squared error for the problem together with a no-bias constraint leads to an integral equation whose solution is the filter. The problem can be solved analytically in terms of the space-time empirical orthogonal function basis set and its eigenvalue spectrum for the natural fluctuations and the projection amplitudes of the sig...

Perceptions of Body Weight, Weight Management Strategies, and Depressive Symptoms Among US College Students

Abstract Objective: To determine if inaccurate body weight perception predicts unhealthy weight management strategies and to determine the extent to which inaccurate body weight perception is associated with depressive symptoms among US college students. Participants: Randomly selected male and female college students in the United States (N = 97,357). Methods: Data were from the 2006 National College Health Assessment. Analyses were conducted on students’ body weight perceptions, weight loss strategies, and feelings of depression. Results: Females with an inflated body weight perception were significantly more likely to engage in unhealthy weight management strategies and report depressive symptoms than were females with an accurate body weight perception. Conclusions: College women are concerned with weight and will take action to lose weight. Colleges may need to focus more on interventions targeting both diet and physical activity while also promoting positive body image.

A Prospective Study of Cardiorespiratory Fitness and Breast Cancer Mortality

PURPOSE Physical activity may protect against breast cancer. Few prospective studies have evaluated breast cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of physiologic response to physical activity habits. METHODS We examined the association between CRF and risk of death from breast cancer in the Aerobics Center Longitudinal Study. Women (N = 14,811), aged 20 to 83 yr with no prior breast cancer history, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1970 and 2001. Mortality surveillance was completed through December 31, 2003. CRF was quantified as maximal treadmill exercise test duration and was categorized for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). At baseline, all participants were able to complete the exercise test to at least 85% of their age-predicted maximal heart rate. RESULTS A total of 68 breast cancer deaths occurred during follow-up (mean = 16 yr). Age-adjusted breast cancer mortality rates per 10,000 woman-years were 4.4, 3.2, and 1.8 for low, moderate, and high CRF groups, respectively (trend P = 0.008). After further controlling for body mass index, smoking, drinking, chronic conditions, abnormal exercise ECG responses, family history of breast cancer, oral contraceptive use, and estrogen use, hazard ratios (95% CI) for breast cancer mortality across incremental CRF categories were 1.00 (referent), 0.67 (0.35-1.26), and 0.45 (0.22-0.95) (trend P = 0.04). CONCLUSIONS These results indicate that CRF is associated with a reduced risk of dying from breast cancer in women.

Estimated Functional Capacity Predicts Mortality in Older Adults

OBJECTIVES: To examine associations between functional capacity estimated from cardiorespiratory fitness (CRF) and mortality risks in adults aged 60 and older.

Fourth-Grade Children's Dietary Recall Accuracy Is Influenced by Retention Interval (Target Period and Interview Time)

BACKGROUND For a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy. OBJECTIVE The effects of target period and interview time on childrens accuracy for reporting school meals during 24-hour dietary recalls were investigated. DESIGN AND SUBJECTS/SETTING: During the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys). MAIN OUTCOME MEASURES Accuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts. STATISTICAL ANALYSES PERFORMED For each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model. RESULTS There was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third. CONCLUSIONS To enhance childrens dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.

The joint effects of cardiorespiratory fitness and adiposity on mortality risk in men with hypertension.

BACKGROUND Whether higher cardiorespiratory fitness (CRF) attenuates the mortality risk associated with higher adiposity in adults with hypertension (HTN) is poorly understood. METHODS Participants were 13,155 men (mean age, 47.7 (s.d., 9.9) years) who completed a baseline health examination and maximal treadmill exercise test during 1974-2003. All men had HTN at baseline based on resting systolic blood pressure of > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg. CRF was quantified as the duration of a symptom-limited maximal treadmill exercise test, and was grouped for analysis as low (lowest 20%), moderate (middle 40%), and high (upper 40%). Distributions of body mass index (BMI), waist circumference (WC), and percent body fat (%BF) were grouped according to standard clinical guidelines. RESULTS During a mean follow-up of 12 years, 883 deaths (355 cardiovascular disease (CVD)) were recorded. Multivariate hazard ratios (HRs) (95% confidence interval) for all-cause mortality, using low-fitness as the reference group, were 0.58 (0.48-0.69) and 0.43 (0.35-0.54) for moderate-fit and high-fit groups, respectively. We observed a similar pattern for CVD mortality. High-fit/obese men had no greater risk of all-cause (1.59 (0.95-2.67)) or CVD (1.23 (0.44-3.41)) death, high-fit/abdominal-obese men had no greater risk for all-cause (1.20 (0.80-1.78)) or CVD (0.62 (0.25-1.53)) death, and high-fit/percent body fat (%BF)-obese men had no greater risk for all-cause (1.19 (0.90-1.56)) or CVD (0.86 (0.52-1.43)) death compared with their high-fit/normal counterparts. CONCLUSIONS Fitness is a powerful effect modifier in the association of adiposity to mortality in men with HTN, negating the all-cause and CVD mortality risk associated with obesity.