Rachel M. Ceballos

Perceived stress, behavior, and body mass index among adults participating in a worksite obesity prevention program, Seattle, 2005-2007.

Introduction Stress in numerous contexts may affect the risk for obesity through biobehavioral processes. Acute stress has been associated with diet and physical activity in some studies; the relationship between everyday stress and such behavior is not clear. The objective of this study was to examine associations between perceived stress, dietary behavior, physical activity, eating awareness, self-efficacy, and body mass index (BMI) among healthy working adults. Secondary objectives were to explore whether eating awareness modified the relationship between perceived stress and dietary behavior and perceived stress and BMI. Methods Promoting Activity and Changes in Eating (PACE) was a group-randomized worksite intervention to prevent weight gain in the Seattle metropolitan area from 2005 through 2007. A subset of 621 participants at 33 worksites provided complete information on perceived stress at baseline. Linear mixed models evaluated cross-sectional associations. Results The mean (standard deviation [SD]) Perceived Stress Scale-10 score among all participants was 12.7 (6.4), and the mean (SD) BMI was 29.2 kg/m2 (6.3 kg/m2). Higher levels of perceived stress were associated with lower levels of eating awareness, physical activity, and walking. Among participants who had low levels of eating awareness, higher levels of perceived stress were associated with fewer servings of fruit and vegetables and greater consumption of fast food meals. Conclusion Dietary and physical activity behaviors of workers may be associated with average levels of perceived stress. Longitudinal studies are needed, however, to support inclusion of stress management or mindfulness techniques in workplace obesity prevention efforts.

Mediators of yoga and stretching for chronic low back pain.

Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.

Colorectal cancer cases and relatives of cases indicate similar willingness to receive and disclose genetic information.

CONTEXT Recent developments in genetic testing allow us to detect individuals with inherited susceptibility to some cancers. Genetic testing to identify carriers of cancer-related mutations may help lower risk by encouraging preventive behaviors and surveillance. This study assessed willingness of colon cancer cases and relatives to receive genetic information that may indicate an increased risk for cancer, to whom they would disclose genetic information, and whether receiving genetic test results may influence future prevention behaviors among individuals enrolled in the Seattle Colorectal Cancer Family Registry. METHODS Incident invasive colorectal cancer cases were identified from the Puget Sound Surveillance Epidemiology and End Results (SEER) registry. In 2007, a sequential sample of cases and relatives (n = 147) were asked to respond to a questionnaire addressing study aims. The questionnaire was administered during a baseline or 5-year follow-up interview. RESULTS Patterns of response to each statement were similar between colorectal cancer cases and relatives. Both colorectal cases (95%) and relatives (95%) reported willingness to receive genetic information. Nearly all participants would tell their doctor the results of a genetic test (99% of cases; 98% of relatives), and all married participants would tell their spouses. Cases (96%) anticipated being slightly more likely than relatives (90%) to change their cancer screening behavior, but this difference was not statistically significant (p = 0.33). CONCLUSIONS A high percentage of both colorectal cancer cases and relatives sampled from the Seattle Colorectal Cancer Family Registry are interested in identifying their genetic status, discussing their genetic status with their family and doctor, and adopting behavioral changes that may reduce cancer risk.

Predictors of Adherence to a 26-Week Viniyoga Intervention Among Post-Treatment Breast Cancer Survivors

OBJECTIVES This study aimed to identify demographic, psychological, health-related, and geographic predictors of adherence to home-based and supervised components of a yoga intervention in breast cancer survivors. METHODS Participants were the 32 post-treatment breast cancer survivors who were randomized to the Viniyoga intervention arm of a controlled trial. Participants were asked to practice yoga 5 times per week for 6 months, including at least one weekly facility-based session. Adherence was monitored using sign-in sheets and logs. Height and weight were measured; other potential predictors of adherence were obtained from baseline questionnaires. RESULTS Participants attended 19.6±13.0 yoga classes and performed 55.8±32.8 home-based yoga sessions. Participants adhered to 58% of the overall yoga practice goal (75% of the goal for yoga classes and 54% of the goal for home based-sessions). Higher class attendance and home practice were predicted by greater self-efficacy for yoga (p=0.004 and 0.06, respectively). Additionally, employment outside the home was associated with greater class attendance (p=0.004), while higher waist circumference was marginally associated with lower adherence to home-based yoga (p=0.05). CONCLUSIONS High levels of facility- and home-based yoga practice were achieved. Breast cancer survivors who have lower self-efficacy for yoga or who have a higher waist circumference may benefit from additional support or intervention tailoring. Adherence may also be improved by ensuring that class times are convenient to both working and nonworking women.

Latino Beliefs About Biomedical Research Participation: A Qualitative Study on the U.S.-Mexico Border

Latinos are under-represented in biomedical research conducted in the United States, impeding disease prevention and treatment efforts for this growing demographic group. We gathered perceptions of biomedical research and gauged willingness to participate through elicitation interviews and focus groups with Latinos living on the U.S.–Mexico border. Themes that emerged included a strong willingness to participate in biomedical studies and suggested that Latinos may be under-represented due to limited formal education and access to health information, not distrust. The conflation of research and clinical care was common and motivated participation. Outreach efforts and educational interventions to inform Latinos of participation opportunities and clarify harms and benefits associated with biomedical research participation will be essential to maintain trust within Latino communities.

Primary prevention, aging, and cancer: overview and future perspectives.

Cancer‐specific primary prevention efforts for the geriatric population are not understood well and currently are underused despite the rapidly growing elderly population. It has been established that lifestyle changes, such as smoking cessation, dietary changes, and increasing physical activity, decrease the incidence of cancer in younger populations. However, a multitude of conceptual, methodological, and dissemination challenges arise when the objective is to apply primary prevention of cancer to the elderly. For this article, the state of the science was reviewed to reveal barriers in the uptake of cancer‐specific primary prevention practices, including the lack of data for the applicability of clinical research findings to older populations. Under‐representation of older adults in behavioral trials and research programs is hindering progress in understanding the physical health and lifestyle choices of older individuals. Efforts directed toward prevention in terms of promoting health behaviors may be not only clinically advantageous but also cost‐effective. In addition, models for translating research findings on primary prevention from younger individuals to the elderly population needs to be addressed. Practitioners need to gain a better understanding of the opportunities for cancer‐specific primary prevention, because such an understanding could enhance the management of chronic disease. Cancer 2008;113(12 suppl)3484–92.

Quality of Life and Mortality of Long-Term Colorectal Cancer Survivors in the Seattle Colorectal Cancer Family Registry

Background and Aim Because most colorectal cancer patients survive beyond five years, understanding quality of life among these long-term survivors is essential to providing comprehensive survivor care. We sought to identify personal characteristics associated with reported quality of life in colorectal cancer survivors, and sub-groups of survivors potentially vulnerable to very low quality of life. Methods We assessed quality of life using the Veterans RAND 12-item Health Survey within a population-based sample of 1,021 colorectal cancer survivors in the Seattle Colorectal Cancer Family Registry, approximately 5 years post-diagnosis. In this case-only study, mean physical component summary scores and mental component summary scores were examined with linear regression. To identify survivors with substantially reduced ability to complete daily tasks, logistic regression was used to estimate odds ratios for “very low” summary scores, defined as a score in the lowest decile of the reference US population. All cases were followed for vital status following QoL assessment, and mortality was analyzed with Cox proportional hazards regression. Results Lower mean physical component summary score was associated with older age, female sex, obesity, smoking, and diabetes or other co-morbidity; lower mean mental component summary score was associated with younger age and female sex. Higher odds of very low physical component summary score was associated with older age, obesity, less education, smoking, co-morbidities, and later stage at diagnosis; smoking was associated with higher odds of very low mental component summary score. A very low physical component score was associated with higher risk of mortality (hazard ratio (95% confidence interval): 3.97 (2.95–5.34)). Conclusions Our results suggest that identifiable sub-groups of survivors are vulnerable to very low physical components of quality of life, decrements that may represent meaningful impairment in completing everyday tasks and are associated with higher risk of death.

Having a diagnosis of diabetes is not associated with general diabetes knowledge in rural Hispanics.

PURPOSE The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic whites. Hispanics also have higher rates of diabetes-related complications and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population. METHODS This study was conducted as part of a larger project in partnership with a local community hospital in Washington States Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5 statements selected from the Diabetes Knowledge Questionnaire. Men and women (N = 1,297) between the ages of 18 and 92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status, and family history of diabetes were tested as predictors of diabetes knowledge. FINDINGS Overall, general knowledge was high with 71%-84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a fifth statement. Although no variable was associated with all statements, family history, gender, and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements. CONCLUSION Contrary to expectations, having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender, and diabetic status as conduits of diabetes education among rural Hispanics.

Stress, Cortisol, and B-Lymphocytes: A Novel Approach to Understanding Academic Stress and Immune Function

Abstract Animal and human in vitro models suggest that stress-related B lymphocyte decrements are due to high levels of glucocorticoids which cause apoptosis of pre-B-cells as they emerge from the bone marrow. The present study sought to explore the relationships among distress, salivary cortisol, and human B lymphocytes in vivo. Distress (perceived stress, negative affect, depressive symptoms), lymphocyte phenotype, and salivary cortisol were assessed among first-year graduate students (n = 22) and a community control sample (n = 30) at the start of classes in the fall and the week immediately before spring preliminary exams. Compared to controls, students reported greater distress on all measures at each time point except baseline perceived stress. Hierarchical linear regression with necessary control variables was used to assess the effect of student status on the three measures of distress, the four measures of lymphocyte phenotype, and cortisol AUC and CAR over time (T1-T2). Student status was associated with a significant decrease in CD19 + B lymphocytes and flattened cortisol awakening response (CAR). Change in CAR was associated with the decrease in CD19 + B lymphocytes. Results indicated that there are significant associations among student status, flattening of CAR, and decrements in CD19 + lymphocytes.

Cognitive Behavioral Stress Management for Healthy Women at Risk for Breast Cancer: a Novel Application of a Proven Intervention

BackgroundWomen at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology.PurposeThe present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer.MethodsParticipants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression.ResultsCBSM participants reported significantly lower posttreatment depressive symptoms (β = −0.17, p < 0.05) and perceived stress (β = −0.23, p < 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress.ConclusionsGroup-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. (Clinicaltrials.gov number NCT00121160)