Nicole L. Nollen

Developmental Trajectories of Overweight During Childhood: Role of Early Life Factors

Objective: Our goal was to identify developmental trajectories of overweight in children and to assess early life influences on these trajectories.

Neural mechanisms underlying food motivation in children and adolescents.

Dramatic increases in childhood obesity necessitate a more complete understanding of neural mechanisms of hunger and satiation in pediatric populations. In this study, normal weight children and adolescents underwent functional magnetic resonance imaging (fMRI) scanning before and after eating a meal. Participants showed increased activation to visual food stimuli in the amygdala, medial frontal/orbitofrontal cortex, and insula in the pre-meal condition; no regions of interest responded in the post-meal condition. These results closely parallel previous findings in adults. In addition, we found evidence for habituation to food stimuli in the amygdala within the pre-meal session. These findings provide evidence that normal patterns of neural activity related to food motivation begin in childhood. Results have implications for obese children and adults, who may have abnormal hunger and satiation mechanisms.

Neural mechanisms underlying hyperphagia in Prader-Willi syndrome.

Objective: Prader‐Willi syndrome (PWS) is a genetic disorder associated with developmental delay, obesity, and obsessive behavior related to food consumption. The most striking symptom of PWS is hyperphagia; as such, PWS may provide important insights into factors leading to overeating and obesity in the general population. We used functional magnetic resonance imaging to study the neural mechanisms underlying responses to visual food stimuli, before and after eating, in individuals with PWS and a healthy weight control (HWC) group.

Smoking Cessation in Homeless Populations: A Pilot Clinical Trial

This study, which tested two motivational interviewing treatment approaches, assessed the feasibility of conducting a community-based smoking cessation intervention among homeless smokers. Participants (N = 46) were recruited from multiple facilities in the Kansas City area and were randomized to two counseling conditions in which they received five individual motivational interviewing sessions, six group meetings, and their choice of 8 weeks of 21-mg nicotine patch or 4-mg nicotine lozenge. The two counseling conditions consisted of motivational interviewing targeted either to smoking behaviors exclusively (smoking only) or to smoking and other addictions or life events that could affect ability to quit (smoking plus). Group meetings were designed to provide educational information and social support. Measures of feasibility assessed included the proportion of participants who returned for randomization among those eligible, adherence to prescribed nicotine replacement therapies, retention rates at the week 26 final study visit, and biochemically verified 7-day abstinence at week 26. Most participants (69.6%) chose nicotine patches, and 32% of those participants reported using at least four patches per week. Carbon monoxide verified 7-day abstinence rates in the smoking-only and smoking-plus groups were 13.04% and 17.39% (ns), respectively, at week 8 and 8.70% and 17.39% (ns), respectively, at week 26. Participants who used at least four patches per week were more likely to have quit at 8 weeks than were those who used fewer patches (33.3% vs. 10.5%, p = .30). Results support the feasibility of conducting a smoking cessation intervention among homeless smokers. Findings also show promising effects for nicotine replacement therapy and counseling in this population. Developing programs to improve smoking cessation outcomes in underserved populations is an essential step toward achieving national health objectives and for ultimately reducing tobacco-related health disparities.

Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Weight‐Related Perceptions Among Patients and Physicians: How Well do Physicians Judge Patients' Motivation to Lose Weight?

AbstractBACKGROUND: Prior studies suggest that patients and physicians have different perceptions and expectations surrounding weight; however, few studies have directly compared patients’ and physicians’ perspectives. OBJECTIVES: (1) To measure the extent to which obese patients and their physicians have discrepant weight-related perceptions, and (2) to explore patient and physician characteristics that may influence patient-physician discrepancy in motivation to lose weight. DESIGN AND PARTICIPANTS: Four hundred and fifty-six obese patients (302 females; mean age =55.1 years; mean BMI =37.9) and their 28 primary care physicians (22 males, mean age =44.1 years) from nonmetropolitan practices completed an anonymous survey after an office visit. MEASURES: Weight-related perceptions included perceived weight status, health impact of weight, 1-year weight loss expectations, and motivation to lose weight. Correlates included patient and physician sex, age, and BMI; physicians’ reported frequency, perceived patient preference, and confidence for weight counseling; and practice characteristics (e.g., years in practice). RESULTS: Physicians assigned patients to heavier descriptive weight categories and reported a worse health impact than patients perceived for themselves, whereas patients believed they could lose more weight and reported a higher motivation to lose weight than their physicians perceived for patients (P <.001). Physicians who believed patients preferred to discuss weight more often (P=.001) and who saw more patients per week (P=.04) were less likely to underestimate patient motivation. CONCLUSIONS: Patients reported more optimistic weight-related perceptions and expectations than their physicians. Further research is needed to determine how these patient-physician discrepancies may influence weight loss counseling in primary care.

Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial

AbstractOBJECTIVE: To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. METHODS: Baseline variables were analyzed as potential predictors from a 2 × 2 cessation trial in which participants were randomly assigned to 1 of 4 treatment groups: nicotine gum plus health education (HE) counseling, nicotine gum plus motivational interviewing (MI) counseling, placebo gum plus HE counseling, or placebo gum plus MI counseling. Chi-square tests, 2 sample t-tests, and multiple logistic regression analyses were used to identify predictors of cotinine (COT) verified abstinence at month 6. RESULTS: In the final regression model, HE rather than MI counseling (odds ratio [OR]=2.26%, 95% confidence interval [CI]=1.36 to 3.74), older age (OR=1.03%, 95% CI=1.01 to 1.06), and higher body mass index (OR=1.04%, 95% CI=1.01 to 1.07) significantly increased the likelihood of quitting, while female gender (OR=0.46%, 95% CI=0.28 to 0.76), ≤

Mobile Technology for Obesity Prevention: A Randomized Pilot Study in Racial- and Ethnic-Minority Girls

1,800/month income (OR=0.60%, 95% CI=0.37 to 0.97), higher baseline COT (OR=0.948%, 95% CI=0.946 to 0.950), and not completing all counseling sessions (OR=0.48%, 95% CI=0.27 to 0.84) reduced the odds of quitting. CONCLUSIONS: Individual characteristics may decrease the likelihood of quitting; however, the provision of directive, advice-oriented counseling focused on the addictive nature of nicotine, health consequences of smoking, benefits of quitting, and development of a concrete quit plan may be an important and effective facilitator of quitting among AA light smokers.

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

BACKGROUND Mobile technologies have wide-scale reach and disseminability, but no known studies have examined mobile technologies as a stand-alone tool to improve obesity-related behaviors of at-risk youth. PURPOSE To test a 12-week mobile technology intervention for use and estimate effect sizes for a fully powered trial. METHODS Fifty-one low-income, racial/ethnic-minority girls aged 9-14 years were randomized to a mobile technology (n=26) or control (n=25) condition. Both conditions lasted 12 weeks and targeted fruits/vegetables (FVs; Weeks 1-4); sugar-sweetened beverages (SSBs; Weeks 5-8), and screen time (Weeks 9-12). The mobile intervention prompted real-time goal setting and self-monitoring and provided tips, feedback, and positive reinforcement related to the target behaviors. Controls received the same content in a written manual but no prompting. Outcomes included device utilization and effect size estimates of FVs, SSBs, screen time, and BMI. Data were collected and analyzed in 2011-2012. RESULTS Mobile technology girls used the program on 63% of days and exhibited trends toward increased FVs (+0.88, p=0.08) and decreased SSBs (-0.33, p=0.09). The adjusted difference between groups of 1.0 servings of FVs (p=0.13) and 0.35 servings of SSBs (p=0.25) indicated small to moderate effects of the intervention (Cohens d=0.44 and -0.34, respectively). No differences were observed for screen time or BMI. CONCLUSIONS A stand-alone mobile app may produce small to moderate effects for FVs and SSBs. Given the extensive reach of mobile devices, this pilot study demonstrates the need for larger-scale testing of similar programs to address obesity-related behaviors in high-risk youth.

Bupropion for Smoking Cessation in African American Light Smokers: A Randomized Controlled Trial

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.