Background. Childhood obesity is a significant but largely modifiable health risk, disproportionately affecting socioeconomically disadvantaged, racial/ethnic minority, and rural children. Elementary school–aged children typically experience the greatest increases in excess weight gain and therefore are important targets for reducing adolescent and adult obesity while improving children’s health. Our study evaluated outcomes of a 3-year elementary school–based program for reducing obesity in American Indian and White students attending eight rural schools in the U.S. upper Midwest. Method. Researchers measured body mass indexes (BMI) and other health indicators and behaviors of 308 beginning third-grade students and then again at the end of students’ third, fourth, and fifth grades. The primary focus of this study is a mixed multilevel longitudinal model testing changes in age- and gender-adjusted BMI z scores ( zBMI). Results. There was a significant decrease in zBMI across the 3-year study period. Ethnicity analyses showed that White students had overall decreases in zBMI whereas American Indian students’ zBMIs remained stable across the program. Comparisons with children from an age- and cohort-matched national sample provided support for the effectiveness of the school program in reducing BMI and obesity during the study period. Conclusion. An elementary school–based health program that addresses a range of students’ obesity-related health behaviors, the school health environment, and that involves educators and parents is an effective intervention for reducing or stabilizing BMI in rural White and American Indian students. School health programs for students living in rural communities may be especially effective due to greater school and community cohesiveness, and valuing of the school’s primary role in improving community health.

Given evidence linking sugary drinks consumption to weight gain, public health proponents are increasingly interested in ways to reduce sugary drinks consumption. This study explored the use of media, specifically, anti-sugary drinks television ads, as a tool for addressing sugary drinks consumption. Ad-related discussion and social norm perceptions are important to media's effects, but to date, these two influences have not been examined separately. To better parse these effects, college students (N = 109) viewed anti-sugary drinks ads either with or without the presence of a friend (a manipulation of social norm perceptions), and either discussed or did not discuss the ads after viewing them. Changes in baseline sugary drinks health knowledge, attitudes toward reducing sugary drinks consumption, and intentions to reduce sugary drinks consumption were examined at post-exposure and one-week follow-up. Consumption levels were also examined at baseline and follow-up. After viewing the ads, participants across conditions reported better sugary drinks health knowledge, more positive attitudes toward reducing sugary drinks consumption, greater intentions to reduce sugary drinks consumption, and lower sugary drinks consumption, although not all effects were maintained at follow-up. Friend presence and discussion did not have substantial effects on outcomes; however, participants that viewed the ads in the presence of a friend maintained positive attitudes toward reducing sugary drinks consumption at follow-up, while those without a friend did not. Results suggest anti-sugary drinks ads are a promising tool for addressing sugary drinks consumption, and that social norm perceptions likely play an important role in explaining media effects.

This study examined the efficacy of motivational interviewing (MI) for increasing physical activity in aging adults. Eighty-six participants aged 55 years and older were randomly assigned to receive either four weekly sessions of telephone-based MI for increasing physical activity, or a healthy activity living guide (information only control). Changes from baseline weekly caloric expenditure from physical activity, self-efficacy for physical activity, and stage of change for physical activity were compared across groups at posttreatment and six months follow-up. Results indicated that MI participants had higher weekly caloric expenditures from physical activity at posttreatment, but not at six months follow-up; higher self-efficacy for physical activity at six months follow-up; and demonstrated greater stage of change progression across assessments. These findings support the use of telephone-based MI for increasing physical activity in older adults in the short-term. Future studies will need to determine if follow-up booster sessions increase long-term efficacy.

IntroductionAntismoking television advertisements that depict the graphic health harms of smoking are increasingly considered best practices, as exemplified by the Centers for Disease Control and Prevention's current national campaign. Evaluation of responses to these widely used advertisements is important to determine advertisements that are most effective and their mechanisms of action. Our study tested the hypothesis that advertisements rated highest in fear-and disgust-eliciting imagery would be rated as the most effective.MethodsOur laboratory study included 144 women and men aged 18 to 33; 84% were current nonsmokers. All participants viewed 6 antismoking television advertisements that depicted the health harms of smoking; they rated their responses of fear and disgust and the effectiveness of the advertisements. We used multilevel modeling to test the effects of the following in predicting effectiveness: fear, disgust, the fear-disgust interaction, the advertisement, and the participant's sex and smoking status. Follow-up analyses examined differences in ratings of fear, disgust, and effectiveness.ResultsAdvertisement, fear, disgust, and the fear-disgust interaction were each significant predictors of effectiveness. Smoking status and sex were not significant predictors. The 3 advertisements that elicited the highest ratings of fear and disgust were rated the most effective.ConclusionOur findings support the hypothesis that antismoking advertisements of health harms that elicit the greatest responses of fear or disgust are the most effective. When advertisements elicit high ratings of both fear and disgust, advertisements with graphic imagery are effective, whereas advertisements without graphic imagery are not.

The cultural norms of a society have a powerful influence over health behavior decisions such as choosing an infant feeding method. The objective of this study was to explore the community breastfeeding perspective by examining breastfeeding attitudes and beliefs, experiences, and behaviors of a U.S. university community through an online survey. Linear and logistic regressions were used to determine predictors of those who had breastfed and those with positive breastfeeding attitudes and beliefs. Through the findings, the researchers suggest that exposure to breastfeeding and increasing positive breastfeeding attitudes and beliefs are important as the focus for public breastfeeding campaigns.

PurposePreventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States.MethodsSelf-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States.FindingsMultinomial logistic regression models were statistically significant for girls ((2)[20] = 42.73, P < .01), boys ((2)[20] = 50.44, P < .001), American Indian ((2)[20] = 36.67, P < .05), and white children ((2)[20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys.ConclusionsLogistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

One of the most widely used treatments for smoking cessation is nicotine replacement therapy (NRT). There is some evidence that smokers experience abstinence-induced deficits in cognitive function, which are attenuated by NRTs. Additionally it's been suggested that the degree of reversal of cognitive deficits may depend on the NRT dose and the smoker's gender. In the present placebo-controlled study we investigated effects of three doses of transdermal nicotine (7 mg, 14 mg and 21 mg) on cognitive performance of 48 male and 48 female smokers after overnight abstinence and 6h of patch application. Cognitive tasks used in the study included the Conners' CPT, emotional Stroop, mental arithmetic, and verbal recall of affective prose passages. The results showed greater probability of attentional problems in the male sample compared to females as identified by the Conners' CPT. Within gender women showed improved performance in the 7 mg and 14 mg conditions on several measures of the Conners' CPT, and faster hit reaction time on the emotional Stroop test compared to women in the placebo and 21 mg of nicotine groups. Conversely, males showed a moderate overall advantage on the mental arithmetic task and were differentially sensitive to nicotine treatment on the prose recall task, on which the greatest improvement in recall of affective material was observed for the 14 mg group compared to the 21 mg group. The results are explained on the basis of an inverted U-shaped relationship between nicotinic stimulation and cognitive performance as well as greater sensitivity to nicotine dose manipulation on gender non-preferred cognitive tasks.

Associations of behavioral health risks and healthy behaviors with self-reported health-related quality of life measures were investigated in a Northern Plains American Indian sample. Participants were surveyed in person using the Behavioral Risk Factor Surveillance Survey. The results showed that regular physical activity was significantly associated with better self-reported overall health, fewer mentally unhealthy and activity limitation days in the past 30 days, and with a greater number of good health days.

Background: The goal of this prospective study was to determine (a) concentrations of the carbohydrate biomarkers Thomsen Friedenreich (TF) antigen and its precursor, Tn antigen, in nipple discharge (ND) collected from women requiring biopsy because of a suspicious breast lesion; and (b) if concentration levels predicted pathologic diagnosis.Methods: Adult women requiring biopsy to exclude breast cancer were enrolled and ND obtained. The samples from 124 women were analyzed using an anti-TF and anti-Tn monoclonal antibodies in direct immunoassay.Results: The highest median concentration in ND for TF and Tn was in women with ductal carcinoma in situ (DCIS). TF was higher in women with 1) cancer (DCIS or invasive) vs. either no cancer (atypia or benign pathology, p = .048), or benign pathology (p = .018); and 2) abnormal (atypia or cancer) versus benign pathology (p = .016); and was more predictive of atypia or cancer in post-compared to premenopausal women. Tn was not predictive of disease. High TF concentration and age were independent predictors of disease, correctly classifying either cancer or abnormal vs. benign pathology 83% of the time in postmenopausal women.Conclusions: TF concentrations in ND were higher in women with precancer and cancer compared to women with benign disease, and TF was an independent predictor of breast atypia and cancer. TF may prove useful in early breast cancer detection.

Objective. We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities. Methods. AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews. Results. AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease. Conclusions. Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

This study was the first to examine rural youth's responses to ten television and radio tobacco countermarketing ads aired during a 13-week field campaign conducted in a U.S. Northern Plains state. A post-campaign survey of 391 girls and boys aged 12-17 years and including 58 American Indian youth provided information about their confirmed recall (CR) of the ads; and for recalled ads, their ratings of the ads' perceived effectiveness (PE). Results were that controlling for age and smoking risk, both American Indian and white girls and boys had the highest CR for the television ad Artery and for the radio ad ABC. Artery shows fatty deposits being squeezed from a deceased smoker's aorta, and ABC presents a former smoker speaking through his electro-larynx. Among the television ads, PE ratings were highest for the ad Artery in both boys and girls. Among the radio ads, boys rated ABC highest, whereas girls rated Joe DoBoer highest-an ad that discusses mouth lesions that developed from using smokeless tobacco. An analysis of race/ethnicity differences in PE for the ad Artery and ABC indicated American Indian and white youth considered these ads equally effective. These findings indicate certain TV and radio ads depicting graphic health harms from tobacco-especially the TV ad Artery and the radio ad ABC-are highly recalled and perceived as effective by both American Indian and white girls and boys from a rural region. Future research is needed to better understand which individual- and media-level factors increase the likelihood that anti-tobacco ads will be effective in reducing youth tobacco use.

Medical management for children with type 1 diabetes mellitus, including insulin administration to control high blood glucose levels (BGL), is crucial. However, a child-controlled behavioural strategy, like physical activity, to maintain target BGL may be warranted. To demonstrate, pre- and post-activity BGL were collected for 73 children aged 8- to 14-years attending a diabetes camp. Change in BGL across one session of a free-play swimming activity was analysed. Average BGL was significantly reduced from 197.18 mg/dl to 177.78 mg/dl across one 45 min session, and male gender predicted larger reductions. With safety precautions and within the context of appropriate medical management, free-play activity could be used as a strategy for maintaining target BGL.

The purpose of the current study was to examine university undergraduate women's and men's attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population.

OBJECTIVETo identify risk factors that may contribute to the development and/or maintenance of overweight and obesity in American Indian children.METHODSThe sample consisted of 291 tribally enrolled American Indian children. Body mass index (BMI) was measured by a tribal program and children completed self-report measures during health class. Hierarchical multiple regression analyses were conducted for 232 children and included three blocks of predictor variables (diet and physical activity, weight-related attitudes, and psychosocial variables).RESULTSThirty-three percent of children were obese and 20% were overweight. Diet and physical activity (7.6%) and weight-related attitudes (31.9%) made significant contributions, explaining 39.5% of the variance in BMI.CONCLUSIONSGreater BMI scores were related to healthier food choice intentions, more hours of television viewing, greater body dissatisfaction, higher negative attitudes toward body size, and more weight loss attempts.

Measures of interest in sexual aggression and overall sexual interest were used to predict men s responses to consensual and nonconsensual stories that contained forceful sexual content. College males (N = 108) listened to these stories and completed questionnaires assessing self-reported sexual arousal and desire, their perceptions of the woman s enjoyment and sexual desire in the stories, their likelihood of acting like the man in the stories, and how likely they would be to read similar stories. Multiple regression analyses revealed that overall sexual interest variables were significant predictors of responses to both consensual and nonconsensual stories, while interest in sexual aggression predicted responses to only the nonconsensual story. The present study highlights the importance of considering overall sexual interest measures in sexual aggression research.

The present study compared the responses of women with headache (chronic tension-type, n = 27; migraine, n = 27) and controls (n = 27) to an acute pain laboratory task, the cold pressor test. Participants' pain perception (i.e., threshold and tolerance) and their fear/anxiety associated with pain were assessed during days 1, 2, or 3 of menses. Analyses pertaining to participants' responses to the cold pressor test (ie, pain threshold and tolerance) failed to show statistically significant group differences, even when covarying pain-related anxiety/fear. Analyses did, however, reveal significant group differences between migraineurs and controls in cognitive anxiety. Correlational analyses also revealed that cognitive anxiety, somatic anxiety, fear, and escape/avoidance were all significantly correlated with pain tolerance in the group with chronic tension-type headache, but not in the other two groups. Subsequent multiple regressions, however, showed that the relationship between anxiety and pain tolerance was primarily a function of somatic anxiety. These results suggest that headache frequency plays a role in mediating the relationship between fear of pain and pain tolerance and that the models by Lethem and colleagues and McCracken may be relevant for understanding tension headache sufferers' responses to head pain.

This study examined the stress‐headache relationship from a disregulation framework by monitoring both physiological responses (eg, pulse, blood volume, skin resistance, and EMG) and self‐reported responses to a stressful event in tension and migraine headache sufferers, as well as in headache‐free controls. Responses were analyzed via time‐series analyses to determine whether self‐reports of stress were correlated with physiological measures of stress. It was hypothesized that tension and migraine headache sufferers would show fewer significant correlations than control participants between their self‐reports of stress and physiological activity. Data analyses supported this hypothesis for tension headache sufferers, but generally not for migraine headache sufferers. The most compelling support for the hypothesis in tension headache sufferers came from the cross‐correlations between self‐reported stress and pulse rate.

When examining headache sufferers' reactivity to stress, few studies attend to differing characteristics of the environment. In this study, we evaluated the influence of the clarity/ambiguity and positive/negative valence of an event on subjects’ physiological and psychological reactivity. Migraine (n=30), tension (n=39) and control (n=35) subjects participated in a laboratory experience in which they had to practice and then deliver a news story to a videocamera (similar to a newscaster on television). During this experience, they received performance feedback and were instructed to try to use the information to improve their performance. In reality, this feedback was noncontingent, with subjects semirandomly assigned to either a positive, negative, or ambiguous feedback condition. Physiological and psychological measures were collected prior to this experience, during an anticipation or practice period prior to the newscast, and during a recovery period following the delivery of the news story. Results suggested that tension subjects might not attend to information from their environment when assessing, responding, or reevaluating potentially stressful events: relying instead on more global beliefs or attributions. Results also indicated that migraine might be associated with a prolonged cardiovascular response (ie, delayed recovery) following a stressful experience.

This study examined daily temporal relationships between stress, cognitive appraisal, coping, and migraine in a group of young women migraineurs sampled from a general population. Participants (N=20) meeting International Headache Society 1 criteria for migraine with or migraine without aura provided headache activity, perceived stress, cognitive appraisal, and coping strategy data across 2 months of data collection. A time‐series analytic approach was used to cross‐correlate daily stress, appraisal, and coping data with daily headache data controlling for factors that can inflate correlations in data collected across time. Analyses revealed that between 50% and 70% of subjects showed significant, substantial, and meaningful temporal correlations between their daily stress and their daily migraine activity. Furthermore, these data support the hypothesis that stress and migraine are reciprocally related (ie, cyclically influencing each other across time). In addition, despite some measurement concerns, our data suggest that cognitive appraisal and coping are also related to migraine activity in a reciprocal fashion.

Poppen (Behavior Relaxation Training and Assessment 1988) has developed an observational method of assessing the degree to which individuals show a relaxation response. Although promising, this method, the Behavioral Rating Scale (BRS), has yet to be thoroughly investigated. Subjects in this study were randomly assigned to a progressive relaxation training group or an attention-control group. Following a training period, subjects participated in a laboratory session in which self-report measures of relaxation were obtained, physiological measures were monitored, and behavioral observations were made using the BRS. Results supported the use of the BRS as a valid, observable measure of an individual's relaxation response. Discriminant validity was demonstrated by between-group differences on the BRS and contruct validity was shown by significant correlations between changes on the BRS and changes on self-report and physiological measures. It is argued that, though alternative explanations are feasible, this study's results support the use of the BRS as an effective assessment tool when measuring an individual's response to progressive muscle relaxation.