Suzanne Shoff

College students' barriers and enablers for healthful weight management: a qualitative study.

OBJECTIVE To identify barriers and enablers for healthful weight management among college students. DESIGN Sixteen on-line focus groups, homogeneous by sex and university. SETTING Eight universities in 8 states. PARTICIPANTS College students (N = 115; 55% female; mean age 19.7 +/- 1.6). ANALYSIS Qualitative software, Nvivo version 2 (QSR International, Victoria, Australia, 2002), was used; similar codes were grouped together and categorized using an ecological model. RESULTS Males and females cited the same barriers to weight management: intrapersonal (eg, temptation and lack of discipline); interpersonal (social situations); and environmental (eg, time constraints, ready access to unhealthful food). Similar enablers were identified by sex: intrapersonal (eg, regulating food intake, being physically active); interpersonal (social support); and environmental (eg, universitys environment supports physical activity). More barriers than enablers were given, indicating that these college students were more sensitive to barriers than the enablers for weight management. Factors viewed by some students as barriers to weight management were viewed as enablers by others. CONCLUSIONS AND IMPLICATIONS When designing weight management interventions for college students, sex specificity may not be as important as considering that a barrier for one student may be an enabler for another. From an ecological perspective, individually focused interventions must be implemented in conjunction with environmental-level interventions to facilitate behavior change.

Impact of an online healthful eating and physical activity program for college students.

Purpose. To identify impact of an online nutrition and physical activity program for college students. Design. Randomized, controlled trial using online questionnaires and on-site physical and fitness assessments with measurement intervals of 0 (baseline), 3 (postintervention), and 15 months (follow-up). Setting. Online intervention delivered to college students; a centralized Web site was used for recruitment, data collection, data management, and intervention delivery. Subjects. College students (18–24 years old, n = 1689), from eight universities (Michigan State University, South Dakota State University, Syracuse University, The Pennsylvania State University, Tuskegee University, University of Rhode Island, University of Maine, and University of Wisconsin). Intervention. A 10-lesson curriculum focusing on healthful eating and physical activity, stressing nondieting principles such as size acceptance and eating competence (software developer: Rainstorm, Inc, Orono, Maine). Measures. Measurements included anthropometrics, cardiorespiratory fitness, fruit/vegetable (FV) intake, eating competence, physical activity, and psychosocial stress. Analysis. Repeated measures analysis of variance for outcome variables. Results. Most subjects were white, undergraduate females (63%), with 25% either overweight or obese. Treatment group completion rate for the curriculum was 84%. Over 15 months, the treatment group had significantly higher FV intake (+.5 cups/d) and physical activity participation (+270 metabolic equivalent minutes per week) than controls. For both groups, anthropometric values and stress increased, and fitness levels decreased. Gender differences were present for most variables. First-year males and females gained more weight than participants in other school years. Conclusion. A 10-week online nutrition and physical activity intervention to encourage competence in making healthful food and eating decisions had a positive, lasting effect on FV intake and maintained baseline levels of physical activity in a population that otherwise experiences significant declines in these healthful behaviors.

Recovery of birth weight z score within 2 years of diagnosis is positively associated with pulmonary status at 6 years of age in children with cystic fibrosis.

OBJECTIVE. We recently reported that 60% of children newly diagnosed with cystic fibrosis who had pancreatic insufficiency responded to treatment initiation and achieved catch-up weight gain to a level comparable with their birth weight z score within 2 years of diagnosis (“responders”), whereas the remaining 40% failed to do so (“nonresponders”). The present study examined the impact of this early weight recovery on subsequent growth pattern and pulmonary status at 6 years of age. PATIENTS AND METHODS. Sixty-three children with cystic fibrosis who had pancreatic insufficiency but no meconium ileus, and were enrolled in the Wisconsin Cystic Fibrosis Neonatal Screening Project, were studied. Responders were defined by a recovery of weight z score comparable with that at birth within 2 years of diagnosis. From ages 2 to 6, growth was measured by both height and BMI. Pulmonary status was evaluated by symptoms, spirometry, quantitative chest radiography, and respiratory microbiology. RESULTS. The majority (71%) of the responders maintained their early weight recovery through 6 years of age, whereas only 32% of the nonresponders achieved substantial growth improvement from 2 to 6 years of age. Proportionately fewer responders reported cough symptoms (10% daytime cough; 22% nighttime cough) compared with nonresponders (41% daytime cough; 45% nighttime cough) at age 6. The percentage of predicted forced expiratory volume in 1 second at age 6 was 11% higher in responders (99.5% ± 13.9%) compared with nonresponders (88.3% ± 18.5%). Responders had significantly better Brasfield (20.1 ± 1.4) and Wisconsin chest radiograph (8.3 ± 3.3) scores compared with nonresponders (Brasfield: 18.9 ± 1.8; Wisconsin: 12.3 ± 8.3). Respiratory microbiology results were not significantly different. Multiple regression analyses indicated that the positive association between responder and percent predicted forced expiratory volume in 1 second at 6 years of age remained statistically significant after controlling for infections with Pseudomonas aeruginosa and Staphylococcus aureus and chest radiograph scores. Growth patterns from 2 to 6 years of age were not associated with pulmonary measures at age 6. CONCLUSIONS. Patients with cystic fibrosis with pancreatic insufficiency who achieved early growth recovery within 2 years of diagnosis had fewer cough symptoms, higher lung function, and better chest radiograph scores at 6 years of age.

Temporal Associations Among Energy Intake, Plasma Linoleic Acid, and Growth Improvement in Response to Treatment Initiation After Diagnosis of Cystic Fibrosis

OBJECTIVE. It is unclear why some patients with cystic fibrosis (CF) succeed (“responders”) in recovering from malnutrition and growth faltering after treatment initiation whereas others fail to do so (“nonresponders”). We conducted a study to test the hypothesis that sustained high energy intake (↑EN) and normal plasma essential fatty acid status are critical determinants of treatment responsiveness within 2 years after diagnosis of CF. METHODS. A total of 71 CF children who had pancreatic insufficiency but not meconium ileus and were enrolled in the Wisconsin CF Neonatal Screening Project were studied. Responders were defined by having achieved adequate weight gain, as indicated by a recovery of weight z score (Wtz) comparable to Wtz at birth (WtzBR) within 2 years of diagnosis. ↑EN and sustained normal plasma linoleic acid level (↑pLA) were defined by achieving energy intake ≥120% of estimated requirement for ≥75% of the time and maintaining plasma LA ≥26% of total fatty acids for ≥75% of the time, respectively. RESULTS. Thirty-two (68%) screened patients and 13 (54%) patients whose CF was diagnosed conventionally recovered WtzBR within 2 years of diagnosis. Screened patients responded at significantly younger ages (mean/median: 6.3/4.3 months) than patients whose CF was diagnosed conventionally (mean/median: 15.8/11.8 months). Proportionately fewer screened patients (33%) achieved ↑EN compared with patients whose CF was diagnosed conventionally (73%). However, more screened patients responded to ↑EN and recovered WtzBR (91%) than patients whose CF was diagnosed conventionally (56%), although this difference was of borderline significance. Compared with having neither ↑EN nor ↑pLA, the likelihood of being a responder was greatest with combined ↑EN and ↑pLA, followed by ↑EN only. The positive associations between ↑EN and ↑pLA to treatment responsiveness remained significant after adjustment for neonatal screening status, baseline height and weight status, and indices of pulmonary disease severity. CONCLUSION. ↑EN and ↑pLA are critical in promoting adequate weight gain in children with newly diagnosed CF.

Eat, Sleep, Work, Play: Associations of Weight Status and Health-Related Behaviors Among Young Adult College Students

Purpose. To examine relationships of sleep, eating, and exercise behaviors; work time pressures; and sociodemographic characteristics by weight status (healthy weight [body mass index or BMI < 25] vs. overweight [BMI ≥ 25]) of young adults. Design. Cross-sectional. Setting. Nine U.S. universities. Subjects. Enrolled college students (N = 1252; 18–24 years; 80% white; 59% female). Measures. Survey included the Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ), Satter Eating Competence Inventory (ecSI), National Cancer Institute Fruit/Vegetable Screener, International Physical Activity Questionnaire, Work Time Pressure items, and sociodemographic characteristics. Analysis. Chi-square and t-tests determined significant bivariate associations of sociodemographics, sleep behaviors, eating behaviors, physical activity behavior, and work time pressures with weight status (i.e., healthy vs. overweight/obese). Statistically significant bivariate associations with weight status were then entered into a multivariate logistic regression model that estimated associations with being overweight/obese. Results. Sex (female), race (nonwhite), older age, higher Global PSQI score, lower ecSI total score, and higher TFEQ Emotional Eating Scale score were significantly (p < .05) associated with overweight/obesity in bivariate analyses. Multivariate logistic regression analysis showed that sex (female; odds ratio [OR] = 2.05, confidence interval [CI] = 1.54–2.74), older age (OR = 1.35, CI= 1.21–1.50), higher Global PSQI score (OR = 1.07, CI = 1.01–1.13), and lower ecSI score (OR = .96, CI = .94–.98), were significantly (p < .05) associated with overweight/obesity. Conclusion. Findings suggest that obesity prevention interventions for college students should include an education component to emphasize the importance of overall sleep quality and improving eating competence.

Process Evaluation of Project WebHealth: A Nondieting Web-based Intervention for Obesity Prevention in College Students

OBJECTIVE To evaluate the motivational effect of the Project WebHealth study procedures and intervention components on weight-related health behavior changes in male and female college students. DESIGN Process evaluation. SETTING Eight universities in the United States. PARTICIPANTS Project WebHealth participants (n = 653; 29% men). MAIN OUTCOME MEASURES Participants rated motivational effects of study procedures and intervention components. Participants were grouped into outcome-based health behavior categories based on achievement of desired targets for fruit and vegetable intake, physical activity, and/or body weight. ANALYSIS Differences in motivation from each procedure and component were analyzed by gender- and outcome-based health behavior category. RESULTS Women were generally more motivated than men. Compared to those who did not meet any target health behaviors, men with improved health outcomes (68%) were significantly more motivated by the skills to fuel the body lesson, goal setting, and research snippets. Their female counterparts (63%) were significantly more motivated by the lessons on body size and eating enjoyment, and by the suggested weekly activities. CONCLUSIONS AND IMPLICATIONS Specific study procedures and components of Project WebHealth motivated study participants to improve their weight-related health behaviors, and they differed by gender. Findings support the need for gender-tailored interventions in this population.

Growth and pulmonary outcomes during the first 2 y of life of breastfed and formula-fed infants diagnosed with cystic fibrosis through the Wisconsin Routine Newborn Screening Program

BACKGROUND The optimal feeding (breast milk, formula, or a combination) for infants with cystic fibrosis (CF) is unknown. Recommendations from the CF Foundation are based on limited data. OBJECTIVE We compared growth and pulmonary outcomes between breastfed and formula-fed infants through the age of 2 y. DESIGN A total of 103 CF infants born in 1994-2006 and diagnosed through newborn screening in Wisconsin were studied. Breastfed infants were classified by the duration of exclusive breastfeeding (ExBF). Exclusive formula-feeding (ExFM) was classified by the formulas caloric density (ie, standard [0.67 kcal/mL (20 kcal/oz) (ExFM20)] throughout infancy or high density [≥0.74 kcal/mL (22 kcal/oz) (ExFM22+)] for some duration of infancy). RESULTS Fifty-three infants (51% of infants) were breastfed and 50 infants (49% of infants) were ExFM. In breastfed infants, the duration of ExBF was <1 mo (53% of infants), 1-1.9 mo (21% of infants), 2-3 mo (17% of infants), and 4-9 mo (9% of infants). In ExFM infants, 23 infants (46%) received a formula with a high caloric density; approximately half (n = 13) of the ExFM infants received the formula by 6 mo of age. Proportionately more infants with pancreatic sufficiency (n = 9) were ExBF ≥1 mo (44% of infants), and none of the infants were ExFM22+, compared with infants with meconium ileus (n = 24; 13% of infants were ExBF ≥1 mo, and 38% of infants were ExFM22+) or pancreatic insufficiency (n = 70; 25% of infants were ExBF ≥1 mo, and 20% of infants were ExFM22+) (P = 0.02). In infants with pancreatic insufficiency, weight z scores declined from birth to 6 mo (P < 0.0001) in infants who were ExBF ≥2 mo, and the number of Pseudomonas aeruginosa infections through the age of 2 y was fewer in breastfed than in ExFM infants (P = 0.003) but did not differ by the duration of ExBF. CONCLUSION For infants with CF, ExBF <2 mo does not compromise growth and is associated with a respiratory benefit.

Usual consumption of plant foods containing phytoestrogens and sex hormone levels in postmenopausal women in Wisconsin

Consumption of phytoestrogens may reduce hormone-dependent cancer risk through alterations in the actions or metabolism of steroid hormones. Studies in humans of phytoestrogen-hormone interactions have been limited and inconsistent. Relations between the consumption of phytoestrogen-containing foods and serum sex hormones and sex hormone-binding globulin were studied in a population-based sample of postmenopausal women who participated in the Nutritional Factors in Eye Disease Study of the Beaver Dam Eye Study. Information on phytoestrogen-containing foods (broccoli, carrots, cauliflower, chili, dark bread, peas, and dried beans) was collected by interviewer-administered food-frequency questionnaires. Estrone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, and total and free testosterone were measured. Analyses included 246 postmenopausal women not taking hormone replacements. Partial correlations between hormones and intake of phytoestrogen-containing foods were computed, with adjustment for age, body mass index, years since menopause, and total energy intake. Number of standard servings per week of whole-grain products from the dark bread group was inversely associated with total testosterone (r = -0.20, p = 0.002). Although not statistically significant, other hormones displayed similar inverse associations with dark bread consistent with a common metabolic pathway. Although the magnitude of association was small, the data are consistent with the possibility that consumption of some phytoestrogen-containing foods may affect levels of testosterone in postmenopausal women.

Nutritional status is associated with health-related quality of life in children with cystic fibrosis aged 9–19 years

BACKGROUND The impact of improved nutritional status on health-related quality of life (HRQOL) is unknown for children with cystic fibrosis (CF). METHODS Associations between nutritional status and HRQOL were examined over 2 years in 95 children, aged 9-19 years, who were followed in the Wisconsin Newborn Screening Project. HRQOL was assessed using the Cystic Fibrosis Questionnaire (CFQ). Associations between height z-score (HtZ), BMI z-score (BMIZ) and seven CFQ dimensions were evaluated. RESULTS Mean values of at least 80 were observed for all CFQ dimensions except respiratory symptoms and treatment burden. Treatment burden was significantly worse in patients with meconium ileus (57) compared to pancreatic insufficient (65) and sufficient (78) subjects, p<0.0001. HtZ and BMIZ were positively associated with physical functioning and body image (p<0.05). CONCLUSIONS Better nutritional status was associated with increased HRQOL scores. Early diagnosis through newborn screening and improved nutrition provides an opportunity to enhance quality of life and body image perception.

Frequency of eating and risk of colorectal cancer in women

Numerous dietary constituents have been extensively studied with regard to colorectal cancer risk, but food intake patterns have been studied less frequently. The purpose of these analyses was to describe associations between frequency of eating and colorectal cancer risk in women. Female Wisconsin residents aged 30-74 years with a diagnosis of colorectal cancer within two years were identified through the statewide tumor registry. Control subjects were randomly selected from lists of licensed drivers (< 65 yrs old) and Medicare beneficiaries (65-74 yrs old). Meal and snack frequency was obtained on a subset of case (n = 189) and control (n = 322) subjects. Odds ratios and 95% confidence intervals (CIs) obtained from conditional logistic regression models were used to estimate multivariate-adjusted relative risks. Compared with women consuming three or four meals daily, women consuming one to two meals daily had an adjusted relative risk of 0.57 (95% CI = 0.34-0.94). Snacking frequency and frequency of meals + snacks were not associated with cancer risk. These results are consistent with other reports and suggest that meal frequency is associated with colorectal cancer risk.