Niaman Nazir

Assessing Overweight, Obesity, Diet, and Physical Activity in College Students

Abstract The authors surveyed 738 college students aged 18 to 27 years to assess overweight, obesity, dietary habits, and physical activity. They used BMI (body mass index) > 25 kg/m2 or BMI > 85th percentile and BMI > 30 kg/m1 or BMI > 95th percentile to estimate overweight and obesity in those aged < 19 years. To define overweight and obesity in those > 20 years, they used BMI > 25 kg/m2 and > 30 kg/m2. They found overweight rates of 21.6% using BMI directly and 16.2% using BMI percentile and obesity rates of 4.9% using BMI directly and 4.2% using BMI percentile. More than 69% of the participants reported < 5 servings of fruits and vegetables per day and more than 67% reported < 20 g of fiber per day; participants reported physical activity on fewer than 3 d/wk. Most college students are not meeting dietary and physical activity guidelines, suggesting the need for prevention interventions and increased understanding of overweight in college students.

Prevalence of Obesity among Adults from Rural and Urban Areas of the United States: Findings from NHANES (2005-2008).

PURPOSE Rural residents have higher rates of chronic diseases compared to their urban counterparts, and obesity may be a major contributor to this disparity. This study is the first analysis of obesity prevalence in rural and urban adults using body mass index classification with measured height and weight. In addition, demographic, diet, and physical activity correlates of obesity across rural and urban residence are examined. METHODS Analysis of body mass index (BMI), diet, and physical activity from 7,325 urban and 1,490 rural adults in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). FINDINGS The obesity prevalence was 39.6% (SE = 1.5) among rural adults compared to 33.4% (SE = 1.1) among urban adults (P = .006). Prevalence of obesity remained significantly higher among rural compared to urban adults controlling for demographic, diet, and physical activity variables (odds ratio = 1.18, P = .03). Race/ethnicity and percent kcal from fat were significant correlates of obesity among both rural and urban adults. Being married was associated with obesity only among rural residents, whereas older age, less education, and being inactive was associated with obesity only among urban residents. CONCLUSIONS Obesity is markedly higher among adults from rural versus urban areas of the United States, with estimates that are much higher than the rates suggested by studies with self-reported data. Obesity deserves greater attention in rural America.

Confirmatory factor analysis of the child-feeding questionnaire among parents of adolescents

We investigated the validity of the child-feeding questionnaire (CFQ) among parents of adolescents. The original CFQ was developed to assess perceptions of obesity-proneness and child-feeding practices among parents of 2- to 11-year-old children. We modified the CFQ to make it applicable to parents of adolescents and added one item on monitoring sugared beverages. Confirmatory factor analysis was conducted using the latent variable approach. Factor scores were related to adolescent body mass index percentiles (BMI%) using structural equation modeling. The modified CFQ was completed by 260 parent/guardians (mean age 39.8 years; 92% female; 55% Black, 35% White, 10% Other). The original published measurement model was fit to our sample and yielded an acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.05). Adding the extra variables decreased the fit; however, minor modifications improved the fit without changing the factor structure (CFI = 0.95, TLI = 0.94, RMSEA = 0.05). Cronbachs alphas for the subscales ranged from 0.60 to 0.88. The factors, parental perceptions of child weight, concern for child weight, monitoring and restriction were positively associated, and pressure to eat was inversely associated with adolescent BMI%. In conclusion, the psychometric properties of the modified CFQ tested among parents of a multi-ethnic adolescent sample were similar to those of the original CFQ.

Characteristics of social smoking among college students.

Abstract. Social smoking is a newly identified phenomenon in the young adult population that is poorly understood. We investigated differences in social smoking (smoking most commonly while partying or socializing) and other smoking within a convenience sample of college smokers (n = 351) from a large midwestern university. Results revealed that 70% of 351 current (past 30-day) smokers reported social smoking. No significant difference was found in motivation to quit between smoking groups. However, a significant difference was found between groups in confidence to quit, the number of days smoked, and the number of cigarettes smoked on those days. More social smokers than expected did not perceive themselves as smokers. Logistic regression analysis revealed that lower physical and psychological dependence and higher social support scores predicted social smoking.

Effect of varying levels of disease management on smoking cessation: a randomized trial.

Context Smoking cessation is difficult and may require repeated or intensive interventions. Contribution In this multicenter trial, 750 primary care patients who smoked at least 10 cigarettes per day were randomly assigned to pharmacotherapy (nicotine patch or bupropion), pharmacotherapy supplemented with up to 2 calls from trained counselors, or pharmacotherapy supplemented with up to 6 counseling calls. Utilization of the interventions, which were offered every 6 months for 2 years, declined over time. Smoking abstinence rates at 2 years were 23%, 24%, and 28% in the 3 groups. Caution Pharmacotherapy was free. Smoking abstinence was self-reported. The Editors Cigarette smoking is a chronic illness characterized by repeated cycles of quit attempts and relapse. Most models for addressing smoking cessation are based on single, short-term interventions lasting only a few weeks or months (1). Although most smokers will not quit after a single intervention, few studies have addressed the chronic nature of nicotine dependence by providing systematic, repetitive treatment opportunities (1). Providing treatment only to smokers who are already prepared to quit further limits the reach of current smoking cessation interventions (2). New models of chronic disease care might provide an alternative approach for expanding the reach and effectiveness of smoking cessation efforts (3). Physicians are in direct contact with approximately 70% of smokers each year (4, 5). Their potential role in promoting smoking cessation has been well delineated and incorporated into current clinical practice guidelines (1). With the development of new, more effective prescription pharmacotherapy for smoking cessation, the role of primary care practices in promoting smoking cessation is now more important than ever. Unfortunately, only half of the smokers who see their physicians are asked about their smoking (6), and even fewer receive advice from their health care provider to quit or receive pharmacotherapy or follow-up (4, 7). Smoking cessation counseling competes with other pressing clinical tasks, and beyond brief advice, many physicians feel they are too busy to routinely and repeatedly counsel participants who smoke (810). To assist primary care physicians in the treatment of rural smokers, we developed KanQuit, a smoking cessation program based on the chronic care model (4), which integrates principles of disease management into the treatment of smokers seen in rural primary care. Our objective was to enroll smokers, regardless of their willingness to quit, into a disease registry and compare cessation rates among smokers who received pharmacotherapy alone or combined with either moderate-intensity or high-intensity disease management that includes counseling and provider feedback. Methods Design Overview We did a randomized, single-blind trial of varying levels of disease management for smoking cessation. We recruited participants who smoked more than 10 cigarettes per day from rural primary care clinics across Kansas and randomly assigned them to receive pharmacotherapy alone, pharmacotherapy supplemented by 1 to 2 counseling calls every 6 months (moderate-intensity disease management), or pharmacotherapy supplemented by up to 6 counseling calls every 6 months (high-intensity disease management). For recipients of moderate-intensity and high-intensity disease management, we faxed periodic progress reports to their physician. We offered all participants free pharmacotherapy (either bupropion or transdermal nicotine patch) every 6 months. We enrolled participants from June 2004 to October 2005 and followed them for 24 months, completing follow-up in December 2007. All participants provided written informed consent. The University of Kansas Medical Centers Human Subjects Committee approved the study. Setting and Participants We conducted our study in 50 rural primary care practices in the Kansas Physicians Engaged in Prevention Research network (11). As part of a rural primary care research experience, trained medical students systematically screened participants, identified smokers, and recruited them for this study, regardless of their interest in quitting (12). We considered smokers eligible if they had a primary care physician who participated in this study; were older than 18 years; smoked more than 10 cigarettes per day for at least 1 year and for at least 25 of the past 30 days; spoke English; and had a telephone. We excluded smokers if they were pregnant or planned to become pregnant, planned to move out of the study area, had signs of dementia or mental illness that would preclude participation, or lived with a smoker already enrolled in the study. Of the 1827 smokers we screened, 61% met criteria for study entry (Figure 1). Of these, we enrolled 67%. Figure 1. Study flow diagram. HDM = high-intensity disease management; MDM = moderate-intensity disease management; PM = pharmacotherapy management. Randomization and Interventions Participant Randomization Randomization occurred at the participant level. A computer-generated random-number table was used to generate allocation cards in blocks of 24, with allocation equally distributed across treatment groups. To conceal allocation, we placed these cards in sequentially numbered, opaque, sealed envelopes. After research assistants verified participant eligibility and completed the baseline assessment, the project director opened the next sequential sealed envelope and determined the participants treatment allocation. One of 9 counselors trained in smoking cessation and motivational interviewing (12) conducted all interventions from a single central site. We assigned participants to counselors without regard to practice site. Pharmacotherapy At baseline, all smokers received a health education mailing that consisted of a welcome letter, information about the use of bupropion and the nicotine patch for smoking cessation, and copies of You Can Quit Smoking: Consumer Guide (13) and When Smokers QuitThe Health Benefits Over Time (14). At baseline and at 6, 12, and 18 months, participants received a mailed offer for free pharmacotherapy that consisted of either a 6-week course of a nicotine patch (21 mg/d) or a 7-week course of sustained-release bupropion (150 mg twice daily). Participants interested in using either medication could return a postage-paid postcard or call a toll-free number. We screened all participants who requested pharmacotherapy for potential contraindications (15). Participants with absolute contraindications for a given drug were ineligible to receive that drug but were offered the option of receiving the other drug. Participants with contraindications to both drugs were not eligible to receive medication from the study but could participate in all other aspects of the intervention. For participants who requested bupropion and those with relative contraindications to the nicotine patch, research staff faxed a prescription request to their primary care physicians. This prescription request delineated any relative contraindications or potential drug interactions. For these participants, their physicians made the final assessment of the appropriateness of the bupropion or the patch. For participants without contraindications to the nicotine patch or on receipt of a faxed, signed prescription, the bupropion or patches were mailed to the participant along with instructions for use. Disease Management In addition to pharmacotherapy, the moderate-intensity and high-intensity disease management groups received educational support, telephone counseling, and periodic progress reports with counseling suggestions faxed to their physician. Every 6 months, they received a KanQuit newsletter that addressed tips on quitting smoking, talking with their physician about smoking, and using pharmacotherapy for cessation. The newsletters were personalized to include study updates, counselor photographs, physician feature stories, and testimonials of participants who had quit smoking. We offered participants assigned to moderate-intensity disease management up to 2 telephone-based counseling sessions every 6 months (1 session to promote a quit attempt and 1 additional follow-up session for those who made a quit attempt). We offered participants assigned to high-intensity disease management up to 6 counseling calls every 6 months to either promote quitting or prevent relapse. We scheduled calls at the participants convenience, and they varied according to the participants quit plan but followed a rough schedule of calls at 1, 3, 6, 9, and 16 weeks after the onset of each 6-month treatment cycle. Counselors used motivational interviewing techniques and followed a semistructured protocol to promote a cessation attempt or, for abstinent smokers, to encourage relapse prevention. During counseling calls, case managers reminded participants about the availability of pharmacotherapy and, for interested participants, provided immediate support for acquiring either the nicotine patch or bupropion, as described previously. We faxed personalized progress reports with suggestions for interventions to the participants physician after the first counseling call (both moderate-intensity and high-intensity disease management participants) and after the last counseling call (high-intensity disease management participants only) during each 6-month cycle. We faxed additional progress reports to the participants physician whenever the moderate-intensity or high-intensity disease management participant set a quit date. Outcomes, Measurements, and Follow-up Research assistants who were blinded to treatment group assignment conducted assessments by telephone at baseline and at 6, 12, 18, and 24 months. Primary Outcome The primary outcome measure was self-reported 7-day abstinence at 24 months, defined as not having smoked a cigarette during the previous 7 days. Although self-reported abstinence has been co

The role of depression and negative affect regulation expectancies in tobacco smoking among college students.

Objective: Expectancies about nicotines ability to alleviate negative mood states may play a role in the relationship between smoking and depression. The authors examined the role of negative affect regulation expectancies as a potential mediator of depression (history of depression and depressive symptoms) and smoking among college students. Participants and Methods: As part of a larger study, 315 undergraduate smokers completed a 296-item survey from January to May of 2001 and 2002. Results: Cross-sectional analyses revealed that negative affect regulation expectancies fully mediated the positive relationship between depressive symptoms and level of smoking. Conclusions: Although depressive symptoms are associated with higher levels of tobacco smoking, the expectation that smoking will reduce negative emotions is 1 factor that accounts for this relationship.

Smoking Characteristics of a Homeless Population

When addressing tobacco control and smoking cessation measures, the homeless have been perceived as a difficult to reach population. The purpose of this study was to examine the smoking characteristics of a homeless population. Data were derived from a larger study that examined smoking among inner‐city residents. Homeless smokers (n = 107) were compared to nonhomeless smokers (n = 491) on sociodemographics, smoking characteristics, motivation to quit, and smoking cessation experiences. Results showed that homeless smokers were more likely to be white, smoke more cigarettes per day, initiate smoking at a younger age, and have a longer smoking history. Knowledge about the risks of smoking and the benefits of quitting was equally high in both groups. Homeless smokers were less likely to be preparing to quit smoking compared to nonhomeless smokers. These factors place homeless smokers at increased risk of tobacco‐related diseases. Programs are needed to design and test effective cessation interventions for homeless smokers.

Baseline Characteristics and Recruitment Strategies in a Randomized Clinical Trial of African-American Light Smokers

Purpose. This study describes the design, recruitment, and baseline data of the first smoking-cessation clinical trial for African-American light smokers, Kick It at Swope II (KIS-II). Design. KIS-II was a randomized trial testing the efficacy of nicotine gum (vs. placebo gum) in combination with counseling (motivational interviewing or health education). Setting. This study was conducted at an urban community-based clinic serving predominantly lower-income African-Americans. Subjects. African-Americans who smoked 1 to 10 cigarettes per day were eligible. Of 1933 individuals screened, 1012 (52%) were eligible and 755 (75%) were enrolled in the study. Measures. Baseline assessment included smoking history and psychometric measures. Analysis. The majority of participants were women (67%) with a mean age of 45.1 years (SD = 10.7). Participants smoked on average 7.6 cigarettes (SD = 3.21) per day, had a mean exhaled carbon monoxide level of 13.9 ppm (SD = 8.9) and a mean serum cotinine level of 244.2 ng/mL (SD = 154.4), and reported high levels of motivation and confidence to quit smoking. Conclusion. African-American light smokers were motivated to stop smoking and to enroll in a smoking-cessation program. Characteristics of our sample suggest African-American light smokers are an appropriate group for inclusion in smoking-cessation interventions.

Quality of diabetes care for adults with developmental disabilities

BACKGROUND Given that individuals with developmental disabilities have a history of difficulty accessing appropriate health care, possess numerous risk factors for diabetes, and frequently have unique needs within the health care setting, it is important to conduct surveillance research to determine the quality of their diabetes care. OBJECTIVE/HYPOTHESIS We assessed the quality of diabetes care for adults with developmental disabilities enrolled in Kansas Medicaid. Developmental disability was defined in accordance with Kansas Medicaid program eligibility and included individuals with intellectual disability, cerebral palsy, autism, and/or seizure disorder. METHODS We identified a retrospective cohort of persons with developmental disabilities who were also diabetic and continuously enrolled in Kansas Medicaid. We tracked their quality of care measures (Hb(A1c)/glucose testing, cholesterol testing, eye examinations, microalbuminaria screening, and primary care visits) across the subsequent 12 months. Quality care measures were evaluated in relation to basic demographic variables and comorbid hypertension using unconditional logistic regression. RESULTS Among 5,960 adults with developmental disability, 666 had diabetes (11.2%). Annual testing rates were Hb(A1c)/glucose testing, 51.7%; cholesterol, 44.3%; eye examinations, 29.3%; and microalbuminaria, 18.5%. Nearly all (93.5%) had contact with a primary care provider during the period. Comorbid hypertension was associated with higher rates of Hb(A1c), cholesterol testing, and primary care visits. Dual eligibility was associated with lower Hb(A1c)/glucose testing and cholesterol testing rates but comparable rates for other measures. Caucasians were more likely to have had an eye examination but less likely to have had their microalbumin checked. CONCLUSIONS Adults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid Program were screened at lower frequency than published national figures for key quality indicators of diabetes care. These results call for action to find approaches to improve their quality of care. Further work is needed to understand the barriers to appropriate care and incentives that will remedy these gaps. In addition, research is needed to determine the accuracy of diabetes identification, treatment, and monitoring of adults with developmental disabilities.

Depressive symptoms and smoking cessation among inner-city African Americans using the nicotine patch

This study examined the relationship between depressive symptoms and smoking cessation among a sample of inner-city African American smokers using the nicotine patch. Analyses were conducted on data from a previous randomized trial that tested the effects of culturally sensitive vs. standard self-help quitting materials. The study sample consisted of 498 African American smokers (mean age = 42.95, SD = 10.40; 60% female) recruited from a large hospital. Participants in both groups received 8 weeks of nicotine replacement therapy. Level of smoking, quit status, and depressive symptoms (Medical Outcomes Survey Short Depression Screen) were assessed at baseline, week 4 (mid-treatment), and 6-month follow-up. Analyses that controlled for randomization group generally did not support the hypothesis that baseline levels of depressive symptoms predict smoking at Week 4 or Month 6. Cross-sectional analyses at each time point indicated that depressive symptoms were positively associated with smoking level (both: beta = 0.24, p < .05). Changes (increases) in depressive symptoms from baseline to week 4 predicted higher smoking levels at follow-up (beta = 0.19, p < .05). Although the results indicated a significant association between depressive symptoms and level of smoking, they generally did not support the notion that depressive symptoms are associated with failure to quit.