Lisa M. Klesges

SMOKING, BODY WEIGHT, AND THEIR EFFECTS ON SMOKING BEHAVIOR: A COMPREHENSIVE REVIEW OF THE LITERATURE

This article provides a comprehensive review of the research on smoking and body weight. The relationships between smoking and body weight are evaluated in 70 cross-sectional and longitudinal investigations. The mechanisms responsible for differences in body weight are discussed, the weight-related issues that promote smoking behavior are reviewed, methods for reducing postcessation weight gain are summarized, and future research directions are proposed. A proposed working research model for studying the relationship between smoking, energy balance, and weight gain is offered. It is concluded that smoking and body weight relationships are closely related and pose significant challenges for smoking researchers.

Effects of obesity, social interactions, and physical environment on physical activity in preschoolers.

Examined demographic, environmental, and parent-child interactional correlates of physical activity in a group of 222 preschoolers. Activity levels were assessed with a system that quantified directly observed physical activity in the natural environment. Using regression-modeling procedures, results revealed a significant relationship between (a) childs relative weight, parental weight status, and percentage of time spent outdoors (environment) and (b) childrens activity levels. Parental obesity was associated with lower levels of physical activity in children, childhood relative weight was associated with slightly higher levels of physical activity, and more outdoor activity was associated with higher activity levels. Parental participation in childrens activities also significantly interacted with levels of parental obesity in predicting activity levels. Those children with a 50% risk for obesity (as defined by both, one, or neither parent being overweight) had small changes in activity across levels of parent-child interaction, whereas those at higher risk for obesity responded with increased activity as parent-child interactions increased. Results are discussed, and the implications of these findings for future intervention efforts are examined.

Behavior change intervention research in healthcare settings: A review of recent reports with emphasis on external validity

BACKGROUND Information to judge both the internal and external validity of health behavior research conducted in healthcare settings is vital to translate research findings to practice. This paper reviews the extent to which this research has reported on elements of internal and external validity, with emphasis on the extent to which research has been conducted in representative settings with representative populations. METHODS A comprehensive review was conducted of controlled interventions for dietary change, physical activity, or smoking cessation conducted in healthcare settings and published in 12 leading health behavior journals between 1996 and 2000. Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, the characteristics and results of these studies were summarized to document the extent to which intervention reach, adoption, implementation, and maintenance were reported and what has been learned about each of these dimensions. RESULTS A total of 36 studies qualified for review. Participation rates among eligible patients were reported in 69% of studies and were generally quite high; in contrast, only 30% of studies reported on participation rates among either healthcare settings or providers. Implementation data were reported in 77% of the studies and these rates were generally high, with the caveat that intervention was often delivered by paid research staff. Long-term maintenance results were reported very consistently at the individual level, but program continuation was almost never reported at the setting level. CONCLUSIONS We conclude that a much stronger emphasis needs to be placed on the representativeness of providers and settings that are studied. Examples of how this can be done and recommendations for future research are provided.

Review of External Validity Reporting in Childhood Obesity Prevention Research

BACKGROUND The translation and dissemination of prevention intervention evidence into practice is needed to address significant public health issues such as childhood obesity. Increased attention to and reporting of external validity information in research publications would allow for better understanding of generalizability issues relevant to successful translation. To demonstrate this potential, recent reports of childhood obesity prevention interventions were evaluated on the extent to which external validity dimensions were reported. METHODS Childhood obesity prevention studies that were controlled, long-term research trials published between 1980 and 2004 that reported a behavioral target of physical activity and/or healthy eating along with at least one anthropometric outcome were identified in 2005. Studies were summarized between 2005 and 2006 using review criteria developed by Green and Glasgow in 2006. RESULTS Nineteen publications met selection criteria. In general, all studies lacked full reporting on potential generalizability and dissemination elements. Median reporting over all elements was 34.5%; the mode was 0% with a range of 0% to 100%. Most infrequent were reports of setting level selection criteria and representativeness, characteristics regarding intervention staff, implementation of intervention content, costs, and program sustainability. CONCLUSIONS The evidence base for future prevention interventions can be improved by enhancing the reporting of contextual and generalizability elements central to translational research. Such efforts face practical hurdles but could provide additional explanation for variability in intervention outcomes, insights into successful adaptations of interventions, and help guide policy decisions.

Practical and Relevant Self-Report Measures of Patient Health Behaviors for Primary Care Research

PURPOSE With increasing evidence for the value of behavior change counseling, there is a need for health behavior measurements that can be implemented in primary care research. This article discusses criteria for and reviews self-report measures to briefly assess cigarette smoking, eating patterns, physical activity, and risky drinking across the life course. It then proposes pragmatic measures for use in practice-based research. METHODS Drawing from literature reviews, previous multisite studies, personal communications with experts in the field, and guidance from an expert panel, we identified self-report behavior change measures and gave priority to items that addressed Healthy People 2010 goals, as well as those that were practical (ie, shorter, and easier to score and use for intervention), were sensitive to change, and produced results that could directly inform primary care intervention. RESULTS Separate recommendations are described for measures for adults and for children/adolescents. We recommend a set of 22 items for adults and 16 items for adolescents to track succinctly their status on the 4 health behaviors above. Perfected measures remain elusive: newly developed measures of physical activity and eating patterns are recommended, and in general, the brief measures for adults are currently better validated than are the child measures. CONCLUSIONS A set of totally satisfactory practical instruments for measuring behavior change in primary care settings does not yet exist. There is sufficient progress to encourage use of and further research on the proposed items. Use of a common set of items across different interventions and projects will help to advance clinical and behavioral research in primary care settings.

Review and special articleBehavior change intervention research in healthcare settings: a review of recent reports with emphasis on external validity

BACKGROUND Information to judge both the internal and external validity of health behavior research conducted in healthcare settings is vital to translate research findings to practice. This paper reviews the extent to which this research has reported on elements of internal and external validity, with emphasis on the extent to which research has been conducted in representative settings with representative populations. METHODS A comprehensive review was conducted of controlled interventions for dietary change, physical activity, or smoking cessation conducted in healthcare settings and published in 12 leading health behavior journals between 1996 and 2000. Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, the characteristics and results of these studies were summarized to document the extent to which intervention reach, adoption, implementation, and maintenance were reported and what has been learned about each of these dimensions. RESULTS A total of 36 studies qualified for review. Participation rates among eligible patients were reported in 69% of studies and were generally quite high; in contrast, only 30% of studies reported on participation rates among either healthcare settings or providers. Implementation data were reported in 77% of the studies and these rates were generally high, with the caveat that intervention was often delivered by paid research staff. Long-term maintenance results were reported very consistently at the individual level, but program continuation was almost never reported at the setting level. CONCLUSIONS We conclude that a much stronger emphasis needs to be placed on the representativeness of providers and settings that are studied. Examples of how this can be done and recommendations for future research are provided.

What Does It Mean to “Employ” the RE-AIM Model?:

Many grant proposals identify the use of a given evaluation model or framework but offer little about how such models are implemented. The authors discuss what it means to employ a specific model, RE-AIM, and key dimensions from this model for program planning, implementation, evaluation, and reporting. The authors report both conceptual and content specifications for the use of the RE-AIM model and a content review of 42 recent dissemination and implementation grant applications to National Institutes of Health that proposed the use of this model. Outcomes include the extent to which proposals addressed the overall RE-AIM model and specific items within the five dimensions in their methods or evaluation plans. The majority of grants used only some elements of the model (less than 10% contained thorough measures across all RE-AIM dimensions). Few met criteria for “fully developed use” of RE-AIM and the percentage of key issues addressed varied from, on average, 45% to 78% across the RE-AIM dimensions. The results and discussion of key criteria should help investigators in their use of RE-AIM and illuminate the broader issue of comprehensive use of evaluation models.

Utilization of counseling and supportive services by female victims of domestic abuse.

Increasing attention to the high prevalence of domestic violence (DV) and its impact on women’s physical and mental health has resulted in expanded services for abused women. Abused women appear to underutilize the formal counseling services available in many communities, however, and further research is needed to identify factors related to service utilization. In the present study, 1,746 women assaulted by a male intimate partner were identified from a larger pool of women interviewed by Pretrial Services following the arrest of their spouse/partner on domestic abuse charges. The women were selected for the current study if they reported prior physical assaults perpetrated by the same spouse/partner listed in the instant offense. In addition to describing previous physical assaults and psychological abuse by their current spouse/partner, women were also asked whether they had ever sought “formal counseling/supportive services” to address the abuse. Consistent with the prior literature, only a minority of the victims reported prior use of these services (14.9%). Additional analyses indicated that the likelihood of having accessed services varied as a function of victim demographic factors (race, relationship to the offender, income), characteristics of the prior DV (prior injury by partner, forced sexual activity, prior psychological abuse), and whether the victim’s children witnessed the fighting. Limitations of the study and implications for service providers and the courts are discussed.

Measurement Reliability and Reactivity Using Repeated Measurements of Resting Energy Expenditure with a Face Mask, Mouthpiece, and Ventilated Canopy

This investigation evaluated the measurement reliability and reactivity of repeated measurements of resting energy expenditure using different methods of data collection. Thirty subjects were randomly assigned to either face mask, mouthpiece/nose clip, or ventilated canopy collection systems for 45 min a day over 3 days. Results indicated that there were no significant differences among data collection systems nor were there any differences either within or between systems over time. Across all three days of measurement, the first 5 min of data collection on all systems were reactive compared to the subsequent 40 min of assessment. Analyses indicated that acceptable reliability coefficients were obtained after 20 min of continuous data collection in the ventilated canopy and after 40 min with the face mask after a 5-min acclimation period. The results suggest that, following an acclimation period, a single 20-min assessment of resting energy expenditure in both a face mask and ventilated canopy are stable and reliable.

The assessment of children's physical activity: a comparison of methods.

The authors assessed the convergent validity and the sources of error in an electronic single-plane accelerometer (i.e., Caltrac Personal Activity Computer (Hemokinetics, Inc., Vienna, VA). The device was validated against observed all-day physical activity levels of children in their natural environment. Thirty pre-school children were observed in non-structured activity for periods of approximately 9 h while wearing the accelerometer. The results revealed moderately high but variable Spearman rank-order correlations between hourly readings of the accelerometer and the observational system (range of correlations = 0.62 to 0.95). An all-day accelerometer reading significantly correlated with the observational instrument (rho = 0.54). A step-wise regression analysis revealed that the best behavioral predictor of the all-day accelerometer reading was the observed behavior of walking, explaining 32% of the total variance. Older vs younger children (i.e., greater than 32.5 months), females vs males, and overweight (i.e., 75 percentile or greater) vs normal weight children tended to show higher correlations between direct observation and accelerometer readings. Implications of these findings and the utilization of the accelerometer in epidemiologic research are discussed.