Biomedical subjects
Publications and source records attributed to Walker S Carlos Poston.
The relationship between parental socialization strategies and child smoking behavior was examined among 170 Latino parents and 85 index children. Maternal support was negatively associated with child smoking whereas siblings' and friends' smoking were positively associated. Studies with larger samples of Latino families are needed to replicate these findings.
BACKGROUND: Obesity is a recognized, preventable risk factor for the development of heart failure (HF); however, little is understood about its effects on patients with established HF. Furthermore, few researchers have assessed obesity's effect on the health status of established HF patients. This study evaluated the influence of obesity on the health status, at baseline and 1 year later, on patients with established HF. METHODS AND RESULTS: Comprehensive clinical data, health status, and obesity classification of 543 HF outpatients from 13 centers was assessed at baseline and 1 year later. Health status was quantified with the generic Short Form-12 and disease-specific Kansas City Cardiomyopathy Questionnaire Overall Summary score. Cross-sectional and longitudinal risk-adjusted general linear models were computed comparing the health status of patients who were classified as either underweight, normal weight, overweight, or obese. Obesity classification was not significantly associated with patients' baseline health status and did not predict 1-year health status. CONCLUSIONS: Although obesity has been reported to confer a survival advantage to patients with HF, it was not associated with better health status at baseline, or after 1 year, in our cohort. Better understanding of the relationship among HF, body weight, and health status is needed before evidence-based recommendations can be made regarding weight management for HF patients.
BACKGROUND: Manipulating the physical environment may be an efficacious way to promote physical activity. This study examined the relationships between features of the neighborhood environment and walking in the neighborhood by U.S. adults. METHODS: A random sample of women (n =266) and men (n =208) aged >18 years participated. Door-to-door interviews were conducted in 2003 to collect information about demographics, walking behavior, and features of the neighborhood environment. RESULTS: The analyses conducted in 2004 revealed that women were more likely to walk for exercise (odds ratio [OR]=4.6, 95% confidence interval [CI]=1.01-20.72) or walk a dog (OR=3.3, 95% CI=1.01-11.08) in the neighborhood if neighborhood safety was average as opposed to below average (p <0.05). Women with an average number of neighborhood destinations were more likely to walk for transportation in the neighborhood (OR=5.7, 95% CI=1.63-19.73) than women with a below average number of neighborhood destinations (p <0.01). In men, none of the neighborhood features were significantly associated with walking for exercise or walking a dog. Men were less likely to walk for transportation in the neighborhood if the functional (OR=0.22, 95% CI=0.06-0.89) or aesthetic (OR=0.17, 95% CI=0.03-0.89) features of the neighborhood were average versus below average. CONCLUSIONS: Prospective studies are needed to determine if changes in neighborhood safety and awareness of neighborhood destinations promote increases in walking by women. Evaluations of the relationships between other environmental features and walking behavior in men are warranted.
Because of the increased risk of comorbid conditions such as type 2 diabetes, hypertension, and osteoarthritis, and the high health care costs associated with obesity, researchers and clinicians continually search for low-cost and effective treatments for weight loss and weight maintenance. In this article we provide an overview of the principles of behavior modification as applied to the treatment of obesity, examine the benefits of augmenting behavioral interventions with pharmacotherapy, and review the use of less-traditional applications of behavior modification in the treatment of obesity, specifically Internet interventions, meal replacements, and telephone interventions. Based on our review, we conclude that these less-traditional approaches can be used effectively to apply the principles of behavior modification, specifically stimulus control and self-monitoring, to obese patients. Future directions for research are outlined, which include examining the use of nontraditional behavioral interventions with children and the development of culturally sensitive interventions for racial and ethnic minority populations.
Biological, psychological, behavioral, and social factors are unable to fully explain or curtail the obesity epidemic. In this article we review research on the influence of the built environment on obesity. Studies were evaluated with regard to their methods of assessing the environment and obesity, as well as to their effects. Methods used to investigate the relationships between the built environment and obesity were found to be dissimilar across studies and varied from indirect to direct. Levels of assessment between and within studies varied from entire counties down to the individual level. Despite this, obesity was linked with area of residence, resources, television, walkability, land use, sprawl, and level of deprivation, showing promise for research utilizing more consistent assessment methods. Recommendations were made to use more direct methods of assessing the environment, which would include specific targeting of institutions thought to vary widely in relation to area characteristics and have a more influential effect on obesity-related behaviors. Interventions should be developed from the individual to the neighborhood level, specifically focusing on the effects of eliminating barriers and making neighborhood level improvements that would facilitate the elimination of obesogenic environments.
Sibutramine is a selective serotonin and noradrenaline re-uptake inhibitor approved for the long-term management of obesity. Its primary mechanism of action is increased satiety, although some evidence also suggests increased energy expenditure could play a role in sibutramine-induced weight loss. It has established general efficacy in long-term trials, with clinically-approved doses of 10 and 15 mg. Sibutramine has also been studied in a number of unique populations, including obese controlled hypertensives, diabetics and ethnic minorities, further establishing its effectiveness. However, it does have a consistent effect of increasing blood pressure and pulse. Thus, blood pressure and heart rate should be monitored in patients using sibutramine and it may not be applicable in obese patients with significant cardiovascular disease.
Depression is a well-established risk factor for cardiovascular disease-related morbidity and mortality. It is common to screen for depression in patients undergoing coronary revascularization prior to revascularization; however, the validity of this assessment is unclear as some patients may experience transient, reactive depression rather than persistent depression. The authors evaluated whether an initial or 1-month postprocedure screen was optimal for identifying consistently depressed patients. Depression at 1-month postprocedure was a stronger predictor of depression at months 2 to 6 than baseline depression. After adjusting potential confounding variables, there was a much stronger relationship between 1-month and 6-month depression status (OR = 28.7 if depressed at 1 month, p < .001) than between baseline and 6-month depression status (OR = 6.5 if depressed at baseline, p < .001). Screening for depression at the time of revascularization is not as predictive of depression at 6 months as it is 1 month postprocedure.
Several studies have demonstrated that a sizeable proportion of patients undergoing coronary artery bypass graft (CABG) demonstrate persistent declines in cognitive functioning. However, several important questions remain regarding cognitive changes following CABG. First, can patients vulnerable to cognitive decline after CABG be identified, providing valuable information that can be factored into clinical decisions? Second, the specificity of CABG as a cause of cognitive decline, when compared to other coronary procedures such as percutaneous coronary interventions, has not been established. Third, what mechanisms account for the neurocognitive decline after CABG? Several mechanisms have been proposed to lead to post-CABG neurocognitive deficits, including pre-CABG neurocognitive deficits, physiological injury, psychosocial factors, and/or the patient's perceptual processes. Finally, no study has demonstrated that cognitive changes, as measured by neuropsychological tests, have ecological validity. Specifically, behavioral sciences research is needed to demonstrate that measured cognitive changes significantly impact health status independent of other risk factors.
PURPOSE: This research examined whether the migration history of overweight Mexican-American women had an independent effect on cardiovascular risk factors, or whether it was mediated by health behavior changes. DATA AND METHODS: Cross-sectional data from 390 overweight, non-diabetic Mexican-American women (aged 18 to 65 years), all recruited from Starr County, Texas, were used for this analysis. Migration history was inferred from birthplaces of subjects and relatives, and length of residence in the United States. Health behaviors included tobacco and alcohol use, sleeping, exercise, and dietary practices. The cardiovascular disease risk factor variables (CDRFVs) studied were plasma glucose, abdominal obesity, blood pressures, and blood lipids. A migration history score (MHS) was developed from factor analysis, almost equally contributed to by the 9 migration history variables. Healthy habits were defined by 6 variables, and 3 factors (blood pressures, lipids/glucose, and body fat/glucose) were used for the CDRFVs. FINDINGS AND CONCLUSION: MHS was correlated positively with socioeconomic status, and negatively with family stress. Older women had healthier drinking and sleeping habits. Women with a higher migration history score exhibited poorer exercise habits, and increased blood pressures. After adjusting for the effect of healthy exercise habits on blood pressures, the impact of migration history on blood pressures became non-significant (P>.05), leading to the conclusion that healthy exercise behaviors mediated the negative relationship of MHS with blood pressures. Age was independently positively correlated with all CDRFVs. Age also weakly moderated the negative relationship of MHS and healthy exercise habits.
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OBJECTIVE: To evaluate the effects of adding exercise and maintenance to cognitive-behavior therapy (CBT) for binge eating disorder (BED) in obese women. METHOD: One hundred fourteen obese female binge eaters were randomized into four groups: CBT with exercise and maintenance, CBT with exercise, CBT with maintenance, and CBT only. RESULTS AND DISCUSSION: Eighty-four women completed the 16-month study. Subjects who received CBT with exercise experienced significant reductions in binge eating frequency compared with subjects who received CBT only. The CBT with exercise and maintenance group had a 58% abstinence rate at the end of the study period and an average reduction of 2.2 body mass index (BMI) units (approximately 14 lb). BMI was significantly reduced in the subjects in both the exercise and maintenance conditions. The results suggest that adding exercise to CBT, and extending the duration of treatment, enhances outcome and contributes to reductions in binge eating and BMI.
This study examined whether overweight or obesity results in greater discharge risk from basic military training (BMT) or during the first year of service in the U.S. Air Force (USAF). Participants were 32,144 male and female airmen who underwent BMT from August 1995 to August 1996 and were classified as underweight (body mass index [BMI] < 18), normal range (BMI = 18-24.9), overweight (BMI = 25-29.9), or obese (BMI > or = 30). Underweight airmen were 63% more likely and overweight airmen were 24% more likely to be medically discharged during BMT compared with individuals in the normal range. Underweight airmen were 22% more likely to be discharged within the first year of service compared with those in the normal range, whereas overweight airmen were 15% less likely to be discharged. These findings do not support overweight or obesity as being major causes for discharge from the USAF within the first year of active duty.
BACKGROUND: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. METHODS: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. RESULTS: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. CONCLUSIONS: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women's depression as well as conducting additional research to further examine predictors of depressive symptoms in men.