Judith Baxter

Pricing and Promotion Effects on Low-Fat Vending Snack Purchases: The CHIPS Study.

OBJECTIVES This study examined the effects of pricing and promotion strategies on purchases of low-fat snacks from vending machines. METHODS Low-fat snacks were added to 55 vending machines in a convenience sample of 12 secondary schools and 12 worksites. Four pricing levels (equal price, 10% reduction, 25% reduction, 50% reduction) and 3 promotional conditions (none, low-fat label, low-fat label plus promotional sign) were crossed in a Latin square design. Sales of low-fat vending snacks were measured continuously for the 12-month intervention. RESULTS Price reductions of 10%, 25%, and 50% on low-fat snacks were associated with significant increases in low-fat snack sales; percentages of low-fat snack sales increased by 9%, 39%, and 93%, respectively. Promotional signage was independently but weakly associated with increases in low-fat snack sales. Average profits per machine were not affected by the vending interventions. CONCLUSIONS Reducing relative prices on low-fat snacks was effective in promoting lower-fat snack purchases from vending machines in both adult and adolescent populations.

Executive Cognitive Abilities and Functional Status Among Community‐Dwelling Older Persons in the San Luis Valley Health and Aging Study

OBJECTIVES: The purpose of this study was to evaluate the contribution of the executive cognitive functions to self‐reported and observed performance of activities of daily living and instrumental activities of daily living.

Diagnostic methods for peripheral arterial disease in the san luis valley diabetes study

Peripheral arterial disease (PAD) is a frequent complication of diabetes mellitus. In the first phase of the San Luis Valley Diabetes Study, diagnostic criteria for PAD were evaluated in 607 controls and 343 diabetics. Normal ranges, and the lowest 2.5 percentile of the distribution of ankle/arm systolic blood pressure ratios were derived from a non-diabetic subset of the population with a very low probability of PAD. From this subgroup, abnormal ankle/arm ratios were defined as less than: 0.94 at rest, 0.73 after exercise, and 0.78 after reactive hyperemia. Using these criteria, PAD was identified in 130 subjects from the study population of 950 (prevalence of 13.7%). In contrast, a history of intermittent claudication, or an absent pulse in the extremity were uncommon findings in the study population, and thus had a low sensitivity and positive predictive value for PAD diagnosed by vascular laboratory criteria. We conclude that vascular laboratory tests provide a useful, and objective means of determining the prevalence of PAD in a geographically-based population of diabetic and control subjects.

Monitoring Dietary Change in a Low-Fat Diet Intervention Study: Advantages of Using 24-Hour Dietary Recalls vs Food Records

OBJECTIVE The purpose of the study was to evaluate two methods of dietary assessment for monitoring change in fat intake in a low-fat diet intervention study. DESIGN The two dietary assessment methods were a 4-day food record (4DFR) and an unannounced 24-hour dietary recall conducted by telephone interview (referred to as a telephone recall [TR]). Subjects were assigned randomly to either a low-fat diet intervention group or a control group that received no counseling about fat intake. Dietary data were collected at baseline, 6 months, and 12 months. SUBJECTS Two hundred ninety postmenopausal women with localized breast cancer were recruited at seven clinical centers in the United States. STATISTICAL ANALYSIS Analysis of variance was used to test for significant differences in mean fat and energy intakes. RESULTS Three sources of error were identified: (a) an instrument effect, suggesting underreporting at baseline of approximately 8% in mean energy intake and 11% in mean fat intake in the TR group compared with the 4DFR group (P = .0001); (b) a repeated measures effect observed for the 4DFR, suggesting underreporting of approximately 7% for energy intake and 14% for fat intake in the control group at 6 and 12 months compared with baseline values (P < .001); and (c) an adherence effect (or compliance bias), suggesting greater compliance to the low-fat intervention diet when subjects were keeping food records than when estimates were based on the unannounced TR. Compared with the TR, the 4DFR overestimated the extent of fat reduction in the low-fat diet intervention group by 41% (P = .08) and 25% (P = .62) at 6 and 12 months, respectively. APPLICATION Multiple days of unannounced 24-hour recalls may be preferable to multiple-day food records for monitoring dietary change in diet intervention studies.

Prevalence and Risk Factors of Diabetic Retinopathy in Non-Hispanic Whites and Hispanics With NIDDM: San Luis Valley Diabetes Study

Diabetic retinopathy (DR) is the leading cause of blindness in adults in the United States. Because photocoagulation can reduce the incidence of blindness from severe DR by ∼50%, it is important to identify people at increased risk for DR so that appropriate treatment can be accomplished. Use of populations at increased risk for diabetes may identify groups at increased risk for complications. A recent report from the San Antonio Heart Study showed that Mexican Americans were at greater risk for servere DR than non-Hispanic Whites. To compare the prevalence of DR between non-Hispanics and Hispanics in southern Colorado, 279 people with non-insulindependent diabetes mellitus (NIDDM) were identified, and retinal photographs identified the presence and severity of retinopathy. The worse eye was used to classify the severity of DR for each patient. Ninety percent of the subjects (166 Hispanics and 85 non-Hispanic Whites) were classified by retinopathy level. The duration-adjusted prevalence of any DR was 41.8% in Hispanics and 54.1% in non-Hispanic Whites. Severe DR (preproliferative and proliferative) occurred in 18.5% of the Hispanics and in 21.3% of the non-Hispanic Whites. The odds ratio for any DR, comparing Hispanics with non-Hispanic Whites adjusted for other risk factors, was 0.40 (95% confidence interval = 0.21, 0.76). Other risk factors for the presence of any retinopathy included use of exogenous insulin, increased duration of diabetes, younger age at diagnosis, increased glycosylated hemoglobin level, and increased systolic blood pressure. These data suggest that, compared with non-Hispanic Whites, Hispanics in Colorado may be at decreased risk for diabetic retinopathy.

Relationship Between Habitual Physical Activity and Insulin Levels Among Nondiabetic Men and Women: San Luis Valley Diabetes Study

Objective To determine whether higher levels of physical activity would be associated with lower fasting insulin and C-peptide levels in a free-living nondiabetic population. Research Design and Methods A cross-sectional study was conducted with a Hispanic and non-Hispanic white population of 442 men and 489 women with normal glucose tolerance (by World Health Organization criteria) in two rural Colorado counties. Total physical activity was assessed by a 7-day physical activity recall from which metabolic equivalents were estimated. Relationships between metabolic equivalents and fasting insulin and C-peptide were assessed while considering obesity, age, and other risk factors known to influence fasting insulin levels. Results Among all subjects, univariate analyses showed that higher activity levels were associated with lower mean fasting insulin and C-peptide levels (P < or equal to 0.05). Multiple linear regression showed that higher activity was significantly associated with lower values of log fasting insulin and C-peptide levels in men only (P < 0.001) independent of obesity, fat distribution, and age. Men in the highest tertile of activity had an adjusted mean fasting insulin level of 59.2 pM and fasting C-peptide level of 0.5 nM compared with a fasting insulin level of 72.7 pM and fasting C-peptide level of 0.6 mM for men in the lowest tertile of activity. The magnitude of the inverse association between activity and insulin was greatest in older rather than younger men. Physical activity was not associated with fasting insulin or C-peptide levels in women in the multivariate analyses. Conclusions Based on cross-sectional data, we conclude that higher levels of habitual physical activity are associated with lower fasting insulin and C-peptide levels in Hispanic and non-Hispanic white men.

Risk Factors For Distal Symmetric Neuropathy in NIDDM: The San Luis Valley Diabetes Study

OBJECTIVE To investigate risk factors for distal symmetric (sensory) neuropathy among prevalent cases of non-insulin-dependent diabetes mellitus (NIDDM) in apopulation-based study in southern Colorado. RESEARCH DESIGN AND METHODS Prevalent neuropathy was identified in 77 of 277 people with NIDDM by a standardized history and neurologic examination. Fifteen known or suspected risk factors for neuropathy were determined without knowledge of neuropathy status. RESULTS Older age at examination, longer duration of diabetes, higher glycohemoglobin percentage, lower fasting C-peptide, insulin use, and presence of retinopathy and nephropathy (microalbumin ≥ 200 µg/ml) were all significantly associated with neuropathy. Sex, ethnicity (Hispanic versus non-Hispanic white), height, systolic blood pressure, peripheral vascular disease, cigarette and alcohol use, and serum lipid levels were not significantly associated with neuropathy. In a multivariate logistic model, increasing age (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1–1.6), longer duration of diabetes (OR = 1.3, CI = 1.0–1.6), increased glycohemoglobin percentage (OR = 1.5, CI = 1.1–2.1), and insulin use (OR = 2.8, CI = 1.3–6.1) were associated with neuropathy. Retinopathy (OR = 3.0, CI = 1.2–7.7), but not nephropathy, was important when added to this model. CONCLUSIONS Worse glycemic control and insulin use were independently associated with neuropathy in people with NIDDM. Whether insulin use represents another marker for severity of the metabolic disturbance or is an independent risk factor for neuropathy requires further study. We could not confirm associations of neuropathy with height, with nephropathy, or with retinopathy, independent of duration of diabetes.

The SUCCESS Project: The Effect of Program Format and Incentives on Participation and Cessation in Worksite Smoking Cessation Programs

OBJECTIVES This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs. METHODS Twenty-four worksites were randomized to 6 conditions that differed in cessation program format and the use of incentives. Programs were offered for 18 months in each worksite. A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation. RESULTS A total of 407 (16.9%) of the smoker cohort registered for programs; on the 12- and 24-month surveys, 15.4% and 19.4% of the cohort, respectively, reported that they had not smoked in the previous 7 days. Registration for programs in incentive sites was almost double that of no-incentive sites (22.4% vs 11.9%), but increased registration did not translate into significantly greater cessation rates. Program type did not affect registration or cessation rates. CONCLUSIONS Although incentives increase rates of registration in worksite smoking cessation programs, they do not appear to increase cessation rates. Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites.

Hospitalization and case fatality for pulmonary embolism in the twin cities: 1979–1984

To better characterize the morbidity from pulmonary embolism, we examined hospital discharge data for all acute care facilities (except for the Veterans Administration Medical Center) in the Minneapolis-St. Paul metropolitan area in each year from 1979 to 1984 for persons aged 30 to 74 years. For each person in whom the discharge diagnoses included pulmonary embolism, the age, sex, year of admission, and vital status at discharge were recorded. Annual age-sex-specific and age-adjusted sex-specific hospitalization rates were calculated. Similar analyses were undertaken for case fatality. With the exception of men younger than 55 years of age, all groups experienced significant decline in the pulmonary embolism discharge rate. No significant temporal changes were observed in any of the case fatality rates. These data suggest that changes in pulmonary embolism mortality in the United States from 1979 to 1984 may reflect declining occurrence of the disease and are likely not the result of changes in case fatality. Further studies in this area are needed.

Indicators of Nutritional Risk in a Rural Elderly Hispanic and Non-Hispanic White Population: San Luis Valley Health and Aging Study

OBJECTIVE To describe the prevalence of nutritional risk factors among elderly residents in a rural Hispanic and non-Hispanic white population. DESIGN A geographically based survey of community-dwelling elderly adults. SUBJECTS/SETTING From July 1993 to July 1995, all Hispanic persons older than 65 years and an age-stratified, random sample of 69% of non-Hispanic white persons, from 2 Colorado counties, were invited to participate in a study of functional impairment and disability (81% responded). After exclusion of 184 respondents who required a surrogate respondent and 8 with missing diet data, the study consisted of 1,006 subjects. Interviews included questions similar to the Nutrition screening Initiative checklist, a 21-item food frequency questionnaire, and anthropometric measures. STATISTICAL ANALYSES PERFORMED Gender- and ethnicity-specific, age-adjusted prevalence for each risk factor was estimated by use of logistic regression. RESULTS Hispanic participants were more likely than non-Hispanic whites to report inadequate intake of vegetables, problems with teeth or dentures that limited the kinds and amounts of food eaten, difficulty preparing meals, and lack of money needed to buy food. Hispanic women reported nutritional risk factors more often than Hispanic men, although anthropometric markers indicated that Hispanic men may be at higher risk of nutritional deficiency. APPLICATIONS/CONCLUSIONS Hispanic men and women had a higher prevalence of nutritional risk factors than non-Hispanic whites. Intervention programs targeting rural, elderly Hispanics should aim to ensure that basic nutrition needs (access to food, help preparing meals, and adequate dental care) are being met. Community programs to increase activity levels and consumption of nutrient-dense foods are recommended.