The Chief Scientist reports... Behavioural risk factors for coronary heart disease and cancers among adults in Edinburgh and Glasgow: assessing change 1988-1995

OBJECTIVE: To assess change over time in selected behavioural risk factors for coronary heart disease and cancers and to assess progress towards government-defined health targets. DESIGN: Computer assisted telephone interview survey, randomly selected sample. SETTING: Edinburgh and Glasgow. SUBJECTS: 34,247 aged 18-60 years; 43.2% male and 56.8% female. MAIN OUTCOME MEASURES: Changes in cigarette smoking, diet, alcohol use and exercise among adults between 1988 and 1995. RESULTS: A majority of the variables under study showed significant change over the time period under review. On the positive side, the percentage of female smokers decreased significantly, whilst the number of female ex-smokers increased; the use of salt and butter declined significantly for men, and butter use declined significantly for women; and increasing numbers of men ate fruit in the last 24 hours and daily. On the negative side, there was no significant decrease in smoking prevalence among men; no significant increase in reported participation in physical activity for exercise for men or women, and a significant decrease in frequency of exercise for women; and the frequency of "drinking heavily on occasion' increased for both men and women. CONCLUSIONS: Significant positive changes in key health behaviours have taken place among adults resident in Edinburgh and Glasgow since 1988, particularly in relation to smoking among women and diet among men, but progress is slow and patchy.     

Problem dieting behaviors among young adolescents

OBJECTIVE: To examine dieting, eating and exercise behaviors, use of diet pills, and vomiting or use of laxatives to lose weight among younger adolescents. DESIGN: Analysis of data from a modified version of the Youth Risk Behavior Survey administered to middle school students in North Carolina in 1995. SETTING: Fifty-three randomly selected middle schools in North Carolina. SUBJECTS: Two thousand three hundred thirty-one students in the sixth, seventh, and eighth grades. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Responses to questions regarding weight control practices, including vomiting or laxative use, dieting, exercise, or diet pill use. RESULTS: Of the students surveyed, 110 (9.7%) of the girls and 46 (4.0%) of the boys reported vomiting or using laxatives to lose weight. Among the girls, vomiting or laxative use was associated with feeling overweight, other weight loss practices, older age, being a poor student, smoking, eating more salads or vegetables, and eating more candy or other sweets (P< or =.01). A logistic regression model consisting of diet pill use, dieting to lose weight, lower academic achievement, and currently trying to lose weight correctly classified 92% of female students who had or had not vomited or used laxatives. Among boys, vomiting or laxative use was associated with feeling overweight, other weight loss practices, minority racial status, smoking, frequency of eating hamburgers or other high-fat meats, and frequency of eating french fries or potato chips (P< or =.01). A model consisting of diet pill use, minority race, dieting to lose weight, smoking, feeling overweight, and number of servings of hamburgers, hot dogs, or barbecue correctly classified 97% of the boys who had or had not vomited or used laxatives. CONCLUSION: Younger adolescents trying to lose weight engage in a variety of problem dieting and weight loss behaviors that can compromise health and may be associated with eating disorders.     

Eating orientation, postcessation weight gain, and continued abstinence among female smokers receiving an unsolicited smoking cessation intervention.

Predictors of weight gain following smoking cessation were assessed among 1,219 female smokers enrolled in a health maintenance organization. Women randomized to the treatment group received a cessation intervention without regard to their interest in quitting smoking. It was hypothesized that cessation would result in subsequent weight gain and postcessation weight gain would be associated with scores on a modified Restraint Scale, the Disinhibition Scale, and a scale assessing tendency to eat during periods of negative affect. Persons who abstained from smoking over the 18-month study gained more weight than did intermittent smokers and continuous smokers, and among 762 women who reported at least 1 on-study attempt to quit smoking, 36% gained weight. Weight gain was associated with disinhibited eating and negative affect eating but not with restrained eating. Weight gain also was associated with continued abstinence from smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Customary physical activity and survival in later life: a study in Nottingham, UK

OBJECTIVE: To assess the value of broadly based customary physical activity scores, derived from a questionnaire inventory, in predicting 10 year mortality among elderly people. DESIGN: A 10 year survival analysis of participants in the first wave of the Nottingham longitudinal study of activity and ageing who, in face to face interviews in 1985, provided detailed information on customary physical activity, health, and lifestyle. SETTING: Urban and suburban Nottingham PARTICIPANTS: A total of 1042 people aged 65 years and over randomly sampled from general practitioner records. MAIN RESULTS: On the basis of factor scores derived from the interview questionnaire, activity levels were graded as "high", "intermediate", or "low". In Cox regression models controlling for age, health status, and cigarette smoking at the time of the activity assessment, these gradings were significantly related to 10 year survival. Relative to the "high" activity groups, the risk of dying was significantly increased in both the "intermediate" (hazard ratio (HR) 1.53; 95% CI 1.12, 2.09) and "low" (HR 2.07; 95% CI 1.53, 2.79) groups for women, and in the "low" group (HR 1.59; 95% CI 1.12, 2.25) for men (p < 0.01 throughout). CONCLUSION: Since the survival model controlled for age, health status, and cigarette smoking, it is unlikely that the activity gradings used here are simple proxies for physical health. It is concluded, therefore, that within the elderly population, recall based survey assessments covering a wide range of customary or habitual physical activities, can provide indices showing both cross sectional utility and predictive validity.     

Biocompatibility of Clearfil Liner Bond 2 and Clearfil AP-X system on nonexposed and exposed primate teeth

Females, especially older women, historically have been excluded from coronary heart disease (CHD) studies. The PrimeTime program was a randomized clinical trial designed to study the effects of a comprehensive lifestyle management program (very low-fat vegetarian diet, smoking cessation, stress-management training, moderate exercise, and group support) on changes in behavioral risk factors among postmenopausal women with CHD. The study also explored program effects on four psychosocial clusters: coping with stress, distress, social support, and self-efficacy. The program produced significant behavioral improvements in 4- and 12-months adherence to diet, physical activity, and stress-management in the PrimeTime women compared to the Usual Care (UC) group. In addition, the PrimeTime participants demonstrated improvements relative to UC on psychosocial measures of self-efficacy, perceived social support, and ability to cope with stress. Strengths and weaknesses of the study, and implications for future research are discussed.     

Depressive symptoms, social support, and personal health behaviors in young men and women.

This study investigated the relationship of depressive symptoms, social support, and a range of personal health behaviors in 2,091 male and 3,438 female university students from 16 countries. Depressive symptoms and social support were measured using the short Beck Depression Inventory and the Social Support Questionnaire; 9 personal health behaviors were also assessed. After the authors took age, social support, and clustering by country into account, depressive symptoms were significantly associated with lack of physical activity, not eating breakfast, irregular sleep hours, and not using a seat belt in both men and women, and additionally with smoking, not eating fruit, and not using sunscreen among women. Low social support was independently associated with low alcohol consumption, lack of physical activity, irregular sleep hours, and not using a seat belt in men and women. Bidirectional causal pathways are likely to link health behaviors with depressed mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight gain following smoking cessation.

Smoking generally suppresses body weight below "normal," and smoking cessation allows weight to return to normal. This weight gain following cessation appears to be due to a transient increase in eating coupled with the removal of acute metabolic effects of each cigarette, with no change in physical activity. Nevertheless, tobacco smoke (and specifically nicotine) does not appear to be simply either an anorectic or a thermogenic agent. Although there may be no easy explanation for the effects of smoking on energy balance, the most parsimonious explanation may be that smoking lowers body weight "set point" and cessation raises set point. The transient changes in eating are therefore secondary to the changes in body weight set point. This notion is supported by animal research with nicotine as well as with other drugs, and it is also supported less directly by the pattern of changes observed with changes in smoking status among humans. A set-point explanation for weight gain after smoking cessation may also help explain the lack of success of interventions designed to prevent this weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of highly physically active smokers in a population of young adult military recruits

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.     

Resisting tempting foods and smoking behavior: Implications from a self-control theory perspective.

Objective: Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking. Design: Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess. Main Outcome Measures: Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable. Results: As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), χ2(1, N = 101) = 3.65 p     

Leisure-time physical activity of first-year students in 3 health science departments

BACKGROUND: Physical inactivity is a well-known risk factor for many chronic diseases which have high prevalence in developed countries. The aims of this study are to describe leisure-time physical activity levels and to identify preferences for its practice among first grade students in three Health Sciences Faculties at the University of Barcelona. METHODS: During the year 1994-95, a total of 887 first grade students of three Faculties, Pharmacy (n = 573), Medicine (n = 222) and Dentistry (n = 92), were interviewed using a recall of their leisure time physical activity over last 8 months. Physical activity level was classified into four categories: non-active, low, medium and high, based on the number of hours per week. Statistical methods consisted in the estimation of rates, comparisons using the chi-square test, and computing the odds ratio. RESULTS: Women were 75% of students. Fifty per cent of men and 71.5% of women referred to be non-active or having low physical activity level (chi 2 = 36.8; DF = 3; p < 0.0001), being no evidence of association with current smoking or overweight (Body Mass Index > or = 25). Among the rest of students, men's most frequently reported activities were football, swimming and tennis, and those of women's were swimming, aerobic and tennis. CONCLUSIONS: Physical activity level among first grade health sciences university students is poorly exemplary. More physical activity promotion is needed, particularly to female students, as an important primary preventive measure among this group.     

Relationship between changes in physical activity and plasma insulin during a 2.5-year follow-up study

The association between changes in physical activity, body weight, and diet and fasting plasma insulin was analyzed in a 2.5-year follow-up study of 146 men aged 50 to 60 years. Physical activity was assessed by a 7-day physical activity recall interview, diet by a 4-day food record, and plasma insulin radioimmunologically. Total physical activity decreased from (mean +/- SD) 45.1 +/- 10.1 to 39.0 +/- 6.1 metabolic equivalent (MET) hours (METh).d-1 and conditioning physical activity (> 5.0 METs) from 8.0 +/- 11.2 to 2.7 +/- 5.0 METh.d-1, whereas plasma insulin increased from 8.2 +/- 5.8 to 9.2 +/- 6.7 mU.L-1 and body weight from 80.5 +/- 12.0 to 81.6 +/- 11.6 kg during the follow-up period (P < or = .001 for all). The change in conditioning physical activity correlated inversely (r = -.34, P < .001) and change in body weight positively (r = .42,P < .001) with the change in plasma insulin level. With data adjusted for the baseline insulin level, cardiovascular health status, alcohol intake, change in body weight, smoking, age, and follow-up time, the odds ratio for an increase in fasting plasma insulin was 8.9 (95% CI, 2.1 to 37.1; P = .003) for men with the greatest decrease in conditioning physical activity (< -7 METh) compared with men who reported an increase in conditioning physical activity. The same logistic regression model showed an odds ratio of 9.9 (95% CI, 2.1 to 45.4; P = .003) for the increase in plasma insulin for subjects who gained more than 3.3 kg body weight compared with subjects who lost at least 0.6 kg. Men who consumed at least 12 g.d-1 alcohol at both examinations had an odds ratio of 12.8 (95% CI, 1.7 to 94.5; P = .012) compared with nondrinkers. These data suggest that in middle-aged men, a reduction in physical activity increases the risk for increased plasma insulin independently of alcohol intake and changes in body weight.     

Behavioral treatment of obese binge eaters: do they need different care?

This study investigated the relationship between binge eating and the outcome of weight loss treatment. Participants in a 48-week trial of a structured diet combined with exercise and behavior therapy were classified into one of four groups: no overeating; episodic overeating; subthreshold binge-eating disorder(BED); and BED. Binge eating status was not associated with either dropout or adherence to the diet, but did affect weight loss and mood. The BED group lost significantly more weight at the end of treatment than all other groups, even when adjusting for initial weight. At 1-year follow-up, there were no differences among groups in weight loss or weight regain. The BED group began treatment with significantly higher BDI scores, but improvement in mood occurred by week 5. On the basis of these findings, and a review of the recent literature, we conclude that obese binge eaters respond as favorably to standard dietary and behavioral treatments as do obese nonbingers.     

Smoking patterns and dependence: Contrasting chippers and heavy smokers.

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)--smokers who smoke despite an apparent absence of tobacco dependence--with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs' urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs' smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs' (but not HSs') smoking was associated with negative affect. In idiographic analyses, CHs' smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: The Winnipeg Health and Drinking Survey.

Smoking cigarettes and drinking alcohol are positively correlated in cross-sectional studies of the general population. However, it is unclear whether changes in quantity of drinking over time are related to changes in amount of smoking over time. This investigation examined, with structural equation modeling, the relationship of changes in drinking to changes in smoking over 2 years among 344 adults who reported cigarette smoking and alcohol use at baseline in 1989-1990 or at follow-up in 1991-1992 or both. Surprisingly, no significant relationships were found between changes in smoking and changes in drinking. This lack of effect suggests that changes in the quantity or intensity of drinking and of smoking are not related in any important way in nonclinical populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms

PURPOSE: Food preferences, eating patterns, and physical activity patterns were examined in a cohort of adolescent females and males participating in a longitudinal study of the developmental antecedents of eating disorders. METHODS: All adolescents (n = 1494) in grades seven through ten in an entire school district completed a survey about their dieting behaviors, eating, and exercise patterns. RESULTS: Principal components analysis showed similar factor structures for food preferences and eating patterns among males and females. Gender differences were present in physical activity patterns. Sports participation was correlated with healthy food preference and was a significant predictor of eating disorders symptoms. Junk food preference was marginally inversely related to eating disorders symptoms in females. Preference for other types of foods and reported intake of foods were not related to eating disorders symptoms. The percent of variance in risk score accounted for by dietary intake and physical activity patterns was small. CONCLUSIONS: Psychological and social/environmental variables may explain a larger proportion of the variance in eating disorders risk than the dietary and physical activity variables examined in this study. Implications for understanding the etiology and behavioral expression of eating disorders are discussed.     

Heterogeneity moderates treatment response among patients with binge eating disorder.

Objective: The purpose of the study was to explore heterogeneity and differential treatment outcome among a sample of patients with binge eating disorder (BED). Method: A latent class analysis was conducted with 205 treatment-seeking, overweight or obese individuals with BED randomized to interpersonal psychotherapy (IPT), behavioral weight loss (BWL), or guided self-help based on cognitive behavioral therapy (CBTgsh). A latent transition analysis tested the predictive validity of the latent class analysis model. Results: A 4-class model yielded the best overall fit to the data. Class 1 was characterized by a lower mean body mass index (BMI) and increased physical activity. Individuals in Class 2 reported the most binge eating, shape and weight concerns, compensatory behaviors, and negative affect. Class 3 patients reported similar binge eating frequencies to Class 2, with lower levels of exercise or compensation. Class 4 was characterized by the highest average BMI, the most overeating episodes, fewer binge episodes, and an absence of compensatory behaviors. Classes 1 and 3 had the highest and lowest percentage of individuals with a past eating disorder diagnosis, respectively. The latent transition analysis found a higher probability of remission from binge eating among those receiving IPT in Class 2 and CBTgsh in Class 3. Conclusions: The latent class analysis identified 4 distinct classes using baseline measures of eating disorder and depressive symptoms, body weight, and physical activity. Implications of the observed differential treatment response are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Calcium intake and the incidence of forearm and hip fractures among men

High calcium intakes are thought to be associated with strong bones and lower risk of fractures. However, findings from epidemiologic studies have not been consistent. In addition, the vast majority of such studies were conducted among women, leading to a relative lack of data concerning men. The objective of this study therefore was to investigate the relation between adult calcium intake and risk of fractures among men in the Health Professionals Follow-up Study (HPFS). During 331,234 person-years of follow-up over an 8-y period, 201 forearm and 56 hip fractures due to low or moderate trauma were reported among 43,063 men 40-75 y of age in 1986 when they first completed a questionnaire about diet and lifestyle factors. After controlling for age, smoking status, body mass index (BMI), physical activity, alcohol consumption and total energy intake, the relative risk (RR) of forearm fractures for men in the highest quintile of calcium intake (from foods plus supplements) compared with those in the lowest quintile was 0.98 [95% confidence interval (CI) = 0.59-1.61; P for trend = 0.78]; for hip fractures, the comparable RR was 1.19 (95% CI = 0.42-3.35; P for trend = 0.58). Relative risks for consuming >2.5 glasses (600 mL) of milk per day compared with one (240 mL) or fewer per week were 1.06 (95% CI = 0.69-1.62; P for trend = 0.82) for forearm fractures and 0.97 (95% CI = 0.39-2.42; P for trend = 0.56) for hip fractures. In conclusion, these results do not support a relation between calcium intake and the incidence of forearm or hip fractures in men.     

Mechanisms by which childhood personality traits influence adult health status: Educational attainment and healthy behaviors.

Objective: The purpose of this study was to test a life span health behavior model in which educational attainment and health behaviors (eating habits, smoking, and physical activity) were hypothesized as mechanisms to account for relations between teacher ratings of childhood personality traits and self-reported health status at midlife. Design: The model was tested on 1,054 members of the Hawaii Personality and Health cohort, which is a population-based cohort participating in a longitudinal study of personality and health spanning 40 years from childhood to midlife. Outcome: Childhood Agreeableness, Conscientiousness, and Intellect-Imagination influenced adult health status indirectly through educational attainment, healthy eating habits, and smoking. Several direct effects of childhood traits on health behaviors and health status were also observed. Conclusion: The model extends past associations found between personality traits and health behaviors or health status by identifying a life-course pathway based on the health behavior model through which early childhood traits influence adult health status. The additional direct effects of personality traits indicate that health behavior mechanisms may not provide a complete account of relations between personality and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the relationship between perceived autonomy support and age in the context of rehabilitation adherence in sport.

Objective: To investigate the relationship between perceived autonomy support, age, and rehabilitation adherence among sports-related injuries. Design: A prospective design measuring adherence over the entire rehabilitation period (8-10 weeks) was employed. Participants: 44 men and 26 women aged between 18 and 55 years took part in this study (M = 32.5 years, SD = 10.2). Method: Adherence was monitored via an observational measure of clinic-based adherence, a self-report measure of home-based adherence, and monitoring of attendance at rehabilitation sessions. Perceived autonomy support of participants was assessed during the last week of their rehabilitation. Results: High autonomy support provided by the physical therapist was related to better clinic-based adherence and attendance but not to home-based adherence. Age was related to all adherence indices and moderated the relationship between perceived autonomy support and clinic-based rehabilitation adherence. Conclusion: Findings indicate the importance of physical therapists providing an autonomous-supportive rehabilitation environment, particularly among older individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-year behavioral treatment of obesity: Comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy.

Compared the weight losses of 49 obese women (mean age 39.31 yrs) randomly assigned to a 52-wk behavioral program combined with either moderate or severe caloric restriction. Ss in the balanced deficit diet (BDD) condition were prescribed a 1,200-kcal/day diet throughout treatment, and those in the very-low-calorie diet (VLCD) condition were given a 420-kcal/day liquid diet for 16 wks and a 1,200-kcal/day diet thereafter. The VLCD Ss lost significantly more weight than the BDD Ss at all periods through Week 26, at which time mean losses were 21.45 and 11.86 kg, respectively. VLCD Ss, however, regained weight during the next 26 wks of weekly therapy and during a 26-wk weight maintenance program that provided biweekly meetings. Mean weight losses at the end of the maintenance program were 10.94 and 12.18 kg, respectively. Reports of binge eating declined in both groups, and no relationship was observed between binge eating and weight loss or attrition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)