Peter Hannan | University of Minnesota - Twin Cities (original) (raw)

Papers by Peter Hannan

Research paper thumbnail of Predictors of Adolescent Breakfast Consumption: Longitudinal Findings from Project EAT

Journal of Nutrition Education and Behavior, 2011

Learning Outcome: Identify factors which affect neonatal weight loss.

Research paper thumbnail of Weight-Related Behaviors Among Adolescent Girls and Boys Results From a National Survey

The study objectives were to assess (1) the prevalence of dieting and disordered eating among ado... more The study objectives were to assess (1) the prevalence of dieting and disordered eating among adolescents; (2) the sociodemographic, anthropometric, psychosocial, and behavioral correlates of dieting and disordered eating; and (3) whether adolescents report having discussed weight-related issues with their health care providers. Cross-sectional school-based survey. A nationally representative sample of 6728 adolescents in grades 5 to 12 who completed the Commonwealth Fund surveys of the health of adolescent girls and boys. Dieting and disordered eating (binge-purge cycling). Approximately 24% of the population was overweight. Almost half of the girls (45%) reported that they had at some point been on a diet, compared with 20% of the boys. Disordered eating was reported by 13% of the girls and 7% of the boys. Strong correlates of these behaviors included overweight status, low self-esteem, depression, suicidal ideation, and substance use. Almost half of the adolescents (38%-53%) reported that a health care provider had at some point discussed nutrition or weight with them. Discussions on eating disorders were reported by lower percentages of girls (24%) and boys (15%). The high prevalence of weight-related concerns suggests that all youth should be reached with appropriate interventions. Special attention needs to be directed toward youth at greatest risk for disordered eating behaviors, such as overweight youth, youth engaging in substance use behaviors, and youth with psychological concerns such as low self-esteem and depressive symptoms.

Research paper thumbnail of Acute Lymphoblastic Leukemia Autologous Versus Unrelated Donor Allogeneic Marrow Transplantation for

Research paper thumbnail of School lunch and snacking patterns among high school students: associations with school food environment and policies

The international journal of behavioral nutrition and physical activity, Jan 6, 2005

This study examined associations between high school students' lunch patterns and vending mac... more This study examined associations between high school students' lunch patterns and vending machine purchases and the school food environment and policies. A randomly selected sample of 1088 high school students from 20 schools completed surveys about their lunch practices and vending machine purchases. School food policies were assessed by principal and food director surveys. The number of vending machines and their hours of operation were assessed by trained research staff. Students at schools with open campus policies during lunchtime were significantly more likely to eat lunch at a fast food restaurant than students at schools with closed campus policies (0.7 days/week vs. 0.2 days/week, p < .001). Student snack food purchases at school were significantly associated with the number of snack machines at schools (p < .001) and policies about the types of food that can be sold. In schools with policies, students reported making snack food purchases an average of 0.5 +/- 1.1...

Research paper thumbnail of Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9-11 year old girls: outcomes of the Cal-Girls study

The international journal of behavioral nutrition and physical activity, Jan 19, 2005

A two-year, community-based, group-randomized trial to promote bone mass gains among 9-11 year-ol... more A two-year, community-based, group-randomized trial to promote bone mass gains among 9-11 year-old girls through increased intake of calcium-rich foods and weight-bearing physical activity was evaluated. Following baseline data collection, 30 5th-grade Girl Scout troops were randomized to a two-year behavioral intervention program or to a no-treatment control group. Evaluations were conducted at baseline, one year, and two years. Measures included bone mineral content, density, and area (measured by DXA), dietary calcium intake (24-hour recall), and weight-bearing physical activity (physical activity checklist interview). Mixed-model regression was used to evaluate treatment-related changes in bone mineral content (g) for the total body, lumbar spine (L1-L4), proximal femur, one-third distal radius, and femoral neck. Changes in eating and physical activity behavioral outcomes were examined. Although the intervention was implemented with high fidelity, no significant intervention eff...

Research paper thumbnail of A pricing strategy to promote sales of lower fat foods in high school cafeterias: acceptability and sensitivity analysis

American journal of health promotion : AJHP

Prices of four low fat foods were reduced about 25% and prices of three high fat foods were incre... more Prices of four low fat foods were reduced about 25% and prices of three high fat foods were increased about 10% to determine the impact on food purchases in a Midwestern suburban high school cafeteria to explore the impact of price on purchases. Low fat foods averaged about 13% of total sales. Sensitivity analysis was used to estimate that low fat foods would probably have averaged about 9% of total sales without the reduced price.

Research paper thumbnail of SCOTLAND

Research paper thumbnail of Safety and characteristics of exercise testing early after acute myocardial infarction

Five hundred and seventy physicians, researchers and clinicians (42% response) responded to a mai... more Five hundred and seventy physicians, researchers and clinicians (42% response) responded to a mailed questionnaire about the safety and nature of exercise testing conducted 14 weeks after acute myocardial infarction (AMI). Of 570 institutions, 193 reported that they routinely performed testing early after AMI and data were provided on 151,949 tests. A majority (111 or 58%) used a low-level testing protocol, 50 (26%) used symptom-limited testing and 32 (16%) used both types. Testing was routinely conducted I14 days after AMI by 147 (76%) respondents, whereas 46 (24%) tested 15 to 28 days after AMI. Thirty-three (17%) respondents used a standardized research protocol and 160 (83%) did not. There were 41 (0.03%) fatal, 141 (0.09%) major nonfatal and 2,124 (1.4%) other cardiac complications reported during testing. No difference in incidence of major complications

Research paper thumbnail of Overweight status and weight control behaviors in adolescents: Longitudinal and secular trends from 1999 to 2004

Preventive Medicine, 2006

Background. This study examined 5-year longitudinal and secular trends in weight status and the u... more Background. This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents.

Research paper thumbnail of Reflection magnitude as a predictor of mortality: the Multi-Ethnic Study of Atherosclerosis

Hypertension, 2014

Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian p... more Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian population. It is unknown whether this association is present in a multiethnic population or whether it is independent of subclinical atherosclerosis. We hypothesized that reflection magnitude (defined as the ratio of the amplitude of the backward wave [Pb] to that of the forward wave [Pf]) is associated with all-cause mortality in a large multiethnic adult community-based sample. We studied 5984 participants enrolled in the Multi-Ethnic Study of Atherosclerosis who had analyzable arterial tonometry waveforms. During 9.8±1.7 years of follow-up, 617 deaths occurred, of which 134 (22%) were adjudicated cardiovascular deaths. In Cox proportional hazards models, each 10% increase in reflection magnitude was associated with a 31% increased risk for all-cause mortality (hazard ratio [HR]=1.31; 95% confidence interval [CI]=1.11-1.55; P=0.001). This relationship persisted after adjustment for var...

Research paper thumbnail of Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis

Hypertension, 2015

Arterial load is composed of resistive and various pulsatile components, but their relative contr... more Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), ...

Research paper thumbnail of Community-wide prevention strategies: Evaluation design of the Minnesota Heart Health Program

Journal of Chronic Diseases, 1986

The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program... more The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program designed to accelerate population-wide changes in coronary risk factors and disease. MHHP is on-going in three pairs of communities in Minnesota, North and South Dakota. To strengthen inference of program effects, its basic design involves elements of control, repetition, sensitive trend measurements and evaluation of the effects of program components. Its evaluation design is presented here as a comprehensive measurement system for disease endpoints, risk factor levels and efficacy of specific educational programs. The MHHP design is able to compare risk factor levels and mortality rates between education and comparison communities. MHHP statistical power is sufficient to detect community-wide changes of public health import. Early results show comparability of education and comparison communities for most variables. Widespread community awareness of and participation in MHHP programs is reported.

Research paper thumbnail of Alcohol and Malt Liquor Availability and Promotion and Homicide in Inner Cities

Substance Use & Misuse, 2008

We investigated the role of the alcohol environment in explaining disparities in homicide rates a... more We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.

Research paper thumbnail of The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines☆☆Surveys available upon request from corresponding author

Preventive Medicine, 2003

This study tested the effects of two organizational support processes, the provision of financial... more This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;control&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (distribution of printed versions of smoking cessation guidelines) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;incentive&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;registry&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; smoking cessation behaviors. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tobacco use status was statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Research paper thumbnail of New moves: a school-based obesity prevention program for adolescent girls

Preventive Medicine, 2003

This study tests the feasibility of an innovative school-based program for obesity prevention amo... more This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class. Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys. The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant. New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.

Research paper thumbnail of Weight Teasing and Disordered Eating Behaviors in Adolescents: Longitudinal Findings From Project EAT (Eating Among Teens)

PEDIATRICS, 2006

OBJECTIVE. To assess whether weight-related teasing predicts the development of binge eating, unh... more OBJECTIVE. To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents.

Research paper thumbnail of Longitudinal and Secular Trends in Weight-related Teasing during Adolescence

Obesity, 2008

Objective: To examine 5-year longitudinal and secular trends in weight-related teasing among adol... more Objective: To examine 5-year longitudinal and secular trends in weight-related teasing among adolescents. Methods and Procedures: Project EAT-II (Eating Among Teens-II) followed 2,516 adolescents (females = 1,386, 55.1%) prospectively from 1999 to 2004. EAT-II included two cohorts allowing the observation of longitudinal changes in reported weight-related teasing as participants transitioned from early to mid-adolescence (middle school to high school) and from mid-to late-adolescence (high school to post-high school). EAT-II also allowed the examination of secular trends in reported teasing among middle adolescents in 1999 and 2004. Results: In 1999, approximately one-quarter of adolescents in the total sample (including both overweight and nonoverweight youth) reported being teased about their weight in early adolescence and mid-adolescence. Prevalence rates of teasing were higher among overweight youth (early adolescence: females 42.4%, males 44.6%; mid-adolescence: females 31.2%, males 40.8%). Longitudinal trends suggest that weight-related teasing decreased among overweight males and females in the younger cohort as they transitioned from early adolescence to midadolescence. In the older cohort of youth, teasing decreased in the total sample of females as they transitioned from mid-adolescence to older adolescence. Analyses of age-matched secular trends among middle adolescents showed that the prevalence of weight-related teasing remained stable among most adolescent subgroups and declined among overweight males between 1999 and 2004. Discussion. Weight-related teasing is prevalent through the various stages of adolescence. Our findings point to a need for ongoing interventions, throughout adolescence, which focus on reducing weight-related teasing and improving social supports for affected youth.

Research paper thumbnail of Predicting Energy Expenditure from Accelerometry Counts in Adolescent Girls

Medicine & Science in Sports & Exercise, 2005

Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has ... more Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has not been conducted in middle school girls. We concurrently assessed energy expenditure and accelerometer counts during physical activities on adolescent girls to develop an equation to predict energy expenditure. Seventy-four girls aged 13-14 yr performed 10 activities while wearing an Actigraph accelerometer and a portable metabolic measurement unit (Cosmed K4b2). The activities were resting, watching television, playing a computer game, sweeping, walking 2.5 and 3.5 mph, performing step aerobics, shooting a basketball, climbing stairs, and running 5 mph. Height and weight were also assessed. Mixed-model regression was used to develop an equation to predict energy expenditure (EE) (kJ.min(-1)) from accelerometer counts. Age (mean [SD] = 14 yr [0.34]) and body-weight-adjusted correlations of accelerometer counts with EE (kJ.min(-1)) for individual activities ranged from -0.14 to 0.59. Higher intensity activities with vertical motion were best correlated. A regression model that explained 85% of the variance of EE was developed: [EE (kJ.min(-1)) = 7.6628 + 0.1462 [(Actigraph counts per minute - 3000)/100] + 0.2371 (body weight in kilograms) - 0.00216 [(Actigraph counts per minute - 3000)/100](2) + 0.004077 [((Actigraph counts per minute - 3000)/100) x (body weight in kilograms)]. The MCCC = 0.85, with a standard error of estimate = 5.61 kJ.min(-1). We developed a prediction equation for kilojoules per minute of energy expenditure from Actigraph accelerometer counts. This equation may be most useful for predicting energy expenditure in groups of adolescent girls over a period of time that will include activities of broad-ranging intensity, and may be useful to intervention researchers interested in objective measures of physical activity.

Research paper thumbnail of Imputation of Missing Data When Measuring Physical Activity by Accelerometry

Medicine & Science in Sports & Exercise, 2005

We consider the issue of summarizing accelerometer activity count data accumulated over multiple ... more We consider the issue of summarizing accelerometer activity count data accumulated over multiple days when the time interval in which the monitor is worn is not uniform for every subject on every day. The fact that counts are not being recorded during periods in which the monitor is not worn means that many common estimators of daily physical activity are biased downward. Data from the Trial for Activity in Adolescent Girls (TAAG), a multicenter group-randomized trial to reduce the decline in physical activity among middle-school girls, were used to illustrate the problem of bias in estimation of physical activity due to missing accelerometer data. The effectiveness of two imputation procedures to reduce bias was investigated in a simulation experiment. Count data for an entire day, or a segment of the day were deleted at random or in an informative way with higher probability of missingness at upper levels of body mass index (BMI) and lower levels of physical activity. When data were deleted at random, estimates of activity computed from the observed data and those based on a data set in which the missing data have been imputed were equally unbiased; however, imputation estimates were more precise. When the data were deleted in a systematic fashion, the bias in estimated activity was lower using imputation procedures. Both imputation techniques, single imputation using the EM algorithm and multiple imputation (MI), performed similarly, with no significant differences in bias or precision. Researchers are encouraged to take advantage of software to implement missing value imputation, as estimates of activity are more precise and less biased in the presence of intermittent missing accelerometer data than those derived from an observed data analysis approach.

Research paper thumbnail of Multiple Sociodemographic and Socioenvironmental Characteristics Are Correlated with Major Patterns of Dietary Intake in Adolescents

Journal of the American Dietetic Association, 2011

Research paper thumbnail of Predictors of Adolescent Breakfast Consumption: Longitudinal Findings from Project EAT

Journal of Nutrition Education and Behavior, 2011

Learning Outcome: Identify factors which affect neonatal weight loss.

Research paper thumbnail of Weight-Related Behaviors Among Adolescent Girls and Boys Results From a National Survey

The study objectives were to assess (1) the prevalence of dieting and disordered eating among ado... more The study objectives were to assess (1) the prevalence of dieting and disordered eating among adolescents; (2) the sociodemographic, anthropometric, psychosocial, and behavioral correlates of dieting and disordered eating; and (3) whether adolescents report having discussed weight-related issues with their health care providers. Cross-sectional school-based survey. A nationally representative sample of 6728 adolescents in grades 5 to 12 who completed the Commonwealth Fund surveys of the health of adolescent girls and boys. Dieting and disordered eating (binge-purge cycling). Approximately 24% of the population was overweight. Almost half of the girls (45%) reported that they had at some point been on a diet, compared with 20% of the boys. Disordered eating was reported by 13% of the girls and 7% of the boys. Strong correlates of these behaviors included overweight status, low self-esteem, depression, suicidal ideation, and substance use. Almost half of the adolescents (38%-53%) reported that a health care provider had at some point discussed nutrition or weight with them. Discussions on eating disorders were reported by lower percentages of girls (24%) and boys (15%). The high prevalence of weight-related concerns suggests that all youth should be reached with appropriate interventions. Special attention needs to be directed toward youth at greatest risk for disordered eating behaviors, such as overweight youth, youth engaging in substance use behaviors, and youth with psychological concerns such as low self-esteem and depressive symptoms.

Research paper thumbnail of Acute Lymphoblastic Leukemia Autologous Versus Unrelated Donor Allogeneic Marrow Transplantation for

Research paper thumbnail of School lunch and snacking patterns among high school students: associations with school food environment and policies

The international journal of behavioral nutrition and physical activity, Jan 6, 2005

This study examined associations between high school students' lunch patterns and vending mac... more This study examined associations between high school students' lunch patterns and vending machine purchases and the school food environment and policies. A randomly selected sample of 1088 high school students from 20 schools completed surveys about their lunch practices and vending machine purchases. School food policies were assessed by principal and food director surveys. The number of vending machines and their hours of operation were assessed by trained research staff. Students at schools with open campus policies during lunchtime were significantly more likely to eat lunch at a fast food restaurant than students at schools with closed campus policies (0.7 days/week vs. 0.2 days/week, p < .001). Student snack food purchases at school were significantly associated with the number of snack machines at schools (p < .001) and policies about the types of food that can be sold. In schools with policies, students reported making snack food purchases an average of 0.5 +/- 1.1...

Research paper thumbnail of Increasing weight-bearing physical activity and calcium-rich foods to promote bone mass gains among 9-11 year old girls: outcomes of the Cal-Girls study

The international journal of behavioral nutrition and physical activity, Jan 19, 2005

A two-year, community-based, group-randomized trial to promote bone mass gains among 9-11 year-ol... more A two-year, community-based, group-randomized trial to promote bone mass gains among 9-11 year-old girls through increased intake of calcium-rich foods and weight-bearing physical activity was evaluated. Following baseline data collection, 30 5th-grade Girl Scout troops were randomized to a two-year behavioral intervention program or to a no-treatment control group. Evaluations were conducted at baseline, one year, and two years. Measures included bone mineral content, density, and area (measured by DXA), dietary calcium intake (24-hour recall), and weight-bearing physical activity (physical activity checklist interview). Mixed-model regression was used to evaluate treatment-related changes in bone mineral content (g) for the total body, lumbar spine (L1-L4), proximal femur, one-third distal radius, and femoral neck. Changes in eating and physical activity behavioral outcomes were examined. Although the intervention was implemented with high fidelity, no significant intervention eff...

Research paper thumbnail of A pricing strategy to promote sales of lower fat foods in high school cafeterias: acceptability and sensitivity analysis

American journal of health promotion : AJHP

Prices of four low fat foods were reduced about 25% and prices of three high fat foods were incre... more Prices of four low fat foods were reduced about 25% and prices of three high fat foods were increased about 10% to determine the impact on food purchases in a Midwestern suburban high school cafeteria to explore the impact of price on purchases. Low fat foods averaged about 13% of total sales. Sensitivity analysis was used to estimate that low fat foods would probably have averaged about 9% of total sales without the reduced price.

Research paper thumbnail of SCOTLAND

Research paper thumbnail of Safety and characteristics of exercise testing early after acute myocardial infarction

Five hundred and seventy physicians, researchers and clinicians (42% response) responded to a mai... more Five hundred and seventy physicians, researchers and clinicians (42% response) responded to a mailed questionnaire about the safety and nature of exercise testing conducted 14 weeks after acute myocardial infarction (AMI). Of 570 institutions, 193 reported that they routinely performed testing early after AMI and data were provided on 151,949 tests. A majority (111 or 58%) used a low-level testing protocol, 50 (26%) used symptom-limited testing and 32 (16%) used both types. Testing was routinely conducted I14 days after AMI by 147 (76%) respondents, whereas 46 (24%) tested 15 to 28 days after AMI. Thirty-three (17%) respondents used a standardized research protocol and 160 (83%) did not. There were 41 (0.03%) fatal, 141 (0.09%) major nonfatal and 2,124 (1.4%) other cardiac complications reported during testing. No difference in incidence of major complications

Research paper thumbnail of Overweight status and weight control behaviors in adolescents: Longitudinal and secular trends from 1999 to 2004

Preventive Medicine, 2006

Background. This study examined 5-year longitudinal and secular trends in weight status and the u... more Background. This study examined 5-year longitudinal and secular trends in weight status and the use of healthy and unhealthy weight control behaviors in adolescents.

Research paper thumbnail of Reflection magnitude as a predictor of mortality: the Multi-Ethnic Study of Atherosclerosis

Hypertension, 2014

Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian p... more Arterial wave reflections have been associated with mortality in an ethnically homogenous Asian population. It is unknown whether this association is present in a multiethnic population or whether it is independent of subclinical atherosclerosis. We hypothesized that reflection magnitude (defined as the ratio of the amplitude of the backward wave [Pb] to that of the forward wave [Pf]) is associated with all-cause mortality in a large multiethnic adult community-based sample. We studied 5984 participants enrolled in the Multi-Ethnic Study of Atherosclerosis who had analyzable arterial tonometry waveforms. During 9.8±1.7 years of follow-up, 617 deaths occurred, of which 134 (22%) were adjudicated cardiovascular deaths. In Cox proportional hazards models, each 10% increase in reflection magnitude was associated with a 31% increased risk for all-cause mortality (hazard ratio [HR]=1.31; 95% confidence interval [CI]=1.11-1.55; P=0.001). This relationship persisted after adjustment for var...

Research paper thumbnail of Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis

Hypertension, 2015

Arterial load is composed of resistive and various pulsatile components, but their relative contr... more Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), ...

Research paper thumbnail of Community-wide prevention strategies: Evaluation design of the Minnesota Heart Health Program

Journal of Chronic Diseases, 1986

The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program... more The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program designed to accelerate population-wide changes in coronary risk factors and disease. MHHP is on-going in three pairs of communities in Minnesota, North and South Dakota. To strengthen inference of program effects, its basic design involves elements of control, repetition, sensitive trend measurements and evaluation of the effects of program components. Its evaluation design is presented here as a comprehensive measurement system for disease endpoints, risk factor levels and efficacy of specific educational programs. The MHHP design is able to compare risk factor levels and mortality rates between education and comparison communities. MHHP statistical power is sufficient to detect community-wide changes of public health import. Early results show comparability of education and comparison communities for most variables. Widespread community awareness of and participation in MHHP programs is reported.

Research paper thumbnail of Alcohol and Malt Liquor Availability and Promotion and Homicide in Inner Cities

Substance Use & Misuse, 2008

We investigated the role of the alcohol environment in explaining disparities in homicide rates a... more We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and malt liquor availability and promotion, and (b) the relationship between neighborhood racial/ethnic concentration and homicide would be attenuated by the greater alcohol and malt liquor availability and promotion in African American neighborhoods. Hypotheses were tested using separate Poisson, linear, and logistic regression models that corrected for spatial autocorrelation. Census block groups served as the unit of analysis (n = 450). We found that higher concentrations of African Americans were associated with higher homicide rates as well as greater alcohol availability, especially malt liquor availability. The promotion of malt liquor on storefronts was also significantly greater in African American than in other neighborhoods. However, none of the measures representing alcohol or malt liquor availability and promotion variables changed the effect of neighborhood racial/ethnic concentration on homicide. Limitations and implications of our findings are discussed.

Research paper thumbnail of The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines☆☆Surveys available upon request from corresponding author

Preventive Medicine, 2003

This study tested the effects of two organizational support processes, the provision of financial... more This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;control&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (distribution of printed versions of smoking cessation guidelines) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;incentive&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;registry&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; smoking cessation behaviors. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tobacco use status was statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Research paper thumbnail of New moves: a school-based obesity prevention program for adolescent girls

Preventive Medicine, 2003

This study tests the feasibility of an innovative school-based program for obesity prevention amo... more This study tests the feasibility of an innovative school-based program for obesity prevention among adolescent girls. New Moves was implemented as a multicomponent, girls-only, high-school physical education class. Six schools were equally randomized into intervention and control conditions. Data were collected at baseline, postintervention, and 8-month follow-up to assess program impact on physical activity, eating patterns, self-perceptions, and body mass index (BMI) among 89 girls in the intervention and 112 girls in the control conditions. Program evaluation also included interviews with school staff, parent surveys, and participant interviews and process evaluation surveys. The feasibility of implementing New Moves was high, as indicated by strong satisfaction among participants, parents, and school staff, and by program sustainability. Participants perceived a positive program impact on their physical activity, eating patterns, and self-image. Girls in the intervention significantly progressed in their stage of behavioral change for physical activity from baseline to follow-up. However, for the majority of outcome variables, differences between intervention and control schools at postintervention and follow-up were not statistically significant. New Moves was well received and fills a needed niche within school physical education programs. An expanded intervention and evaluation is needed to enhance and assess long-term program effectiveness.

Research paper thumbnail of Weight Teasing and Disordered Eating Behaviors in Adolescents: Longitudinal Findings From Project EAT (Eating Among Teens)

PEDIATRICS, 2006

OBJECTIVE. To assess whether weight-related teasing predicts the development of binge eating, unh... more OBJECTIVE. To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents.

Research paper thumbnail of Longitudinal and Secular Trends in Weight-related Teasing during Adolescence

Obesity, 2008

Objective: To examine 5-year longitudinal and secular trends in weight-related teasing among adol... more Objective: To examine 5-year longitudinal and secular trends in weight-related teasing among adolescents. Methods and Procedures: Project EAT-II (Eating Among Teens-II) followed 2,516 adolescents (females = 1,386, 55.1%) prospectively from 1999 to 2004. EAT-II included two cohorts allowing the observation of longitudinal changes in reported weight-related teasing as participants transitioned from early to mid-adolescence (middle school to high school) and from mid-to late-adolescence (high school to post-high school). EAT-II also allowed the examination of secular trends in reported teasing among middle adolescents in 1999 and 2004. Results: In 1999, approximately one-quarter of adolescents in the total sample (including both overweight and nonoverweight youth) reported being teased about their weight in early adolescence and mid-adolescence. Prevalence rates of teasing were higher among overweight youth (early adolescence: females 42.4%, males 44.6%; mid-adolescence: females 31.2%, males 40.8%). Longitudinal trends suggest that weight-related teasing decreased among overweight males and females in the younger cohort as they transitioned from early adolescence to midadolescence. In the older cohort of youth, teasing decreased in the total sample of females as they transitioned from mid-adolescence to older adolescence. Analyses of age-matched secular trends among middle adolescents showed that the prevalence of weight-related teasing remained stable among most adolescent subgroups and declined among overweight males between 1999 and 2004. Discussion. Weight-related teasing is prevalent through the various stages of adolescence. Our findings point to a need for ongoing interventions, throughout adolescence, which focus on reducing weight-related teasing and improving social supports for affected youth.

Research paper thumbnail of Predicting Energy Expenditure from Accelerometry Counts in Adolescent Girls

Medicine & Science in Sports & Exercise, 2005

Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has ... more Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has not been conducted in middle school girls. We concurrently assessed energy expenditure and accelerometer counts during physical activities on adolescent girls to develop an equation to predict energy expenditure. Seventy-four girls aged 13-14 yr performed 10 activities while wearing an Actigraph accelerometer and a portable metabolic measurement unit (Cosmed K4b2). The activities were resting, watching television, playing a computer game, sweeping, walking 2.5 and 3.5 mph, performing step aerobics, shooting a basketball, climbing stairs, and running 5 mph. Height and weight were also assessed. Mixed-model regression was used to develop an equation to predict energy expenditure (EE) (kJ.min(-1)) from accelerometer counts. Age (mean [SD] = 14 yr [0.34]) and body-weight-adjusted correlations of accelerometer counts with EE (kJ.min(-1)) for individual activities ranged from -0.14 to 0.59. Higher intensity activities with vertical motion were best correlated. A regression model that explained 85% of the variance of EE was developed: [EE (kJ.min(-1)) = 7.6628 + 0.1462 [(Actigraph counts per minute - 3000)/100] + 0.2371 (body weight in kilograms) - 0.00216 [(Actigraph counts per minute - 3000)/100](2) + 0.004077 [((Actigraph counts per minute - 3000)/100) x (body weight in kilograms)]. The MCCC = 0.85, with a standard error of estimate = 5.61 kJ.min(-1). We developed a prediction equation for kilojoules per minute of energy expenditure from Actigraph accelerometer counts. This equation may be most useful for predicting energy expenditure in groups of adolescent girls over a period of time that will include activities of broad-ranging intensity, and may be useful to intervention researchers interested in objective measures of physical activity.

Research paper thumbnail of Imputation of Missing Data When Measuring Physical Activity by Accelerometry

Medicine & Science in Sports & Exercise, 2005

We consider the issue of summarizing accelerometer activity count data accumulated over multiple ... more We consider the issue of summarizing accelerometer activity count data accumulated over multiple days when the time interval in which the monitor is worn is not uniform for every subject on every day. The fact that counts are not being recorded during periods in which the monitor is not worn means that many common estimators of daily physical activity are biased downward. Data from the Trial for Activity in Adolescent Girls (TAAG), a multicenter group-randomized trial to reduce the decline in physical activity among middle-school girls, were used to illustrate the problem of bias in estimation of physical activity due to missing accelerometer data. The effectiveness of two imputation procedures to reduce bias was investigated in a simulation experiment. Count data for an entire day, or a segment of the day were deleted at random or in an informative way with higher probability of missingness at upper levels of body mass index (BMI) and lower levels of physical activity. When data were deleted at random, estimates of activity computed from the observed data and those based on a data set in which the missing data have been imputed were equally unbiased; however, imputation estimates were more precise. When the data were deleted in a systematic fashion, the bias in estimated activity was lower using imputation procedures. Both imputation techniques, single imputation using the EM algorithm and multiple imputation (MI), performed similarly, with no significant differences in bias or precision. Researchers are encouraged to take advantage of software to implement missing value imputation, as estimates of activity are more precise and less biased in the presence of intermittent missing accelerometer data than those derived from an observed data analysis approach.

Research paper thumbnail of Multiple Sociodemographic and Socioenvironmental Characteristics Are Correlated with Major Patterns of Dietary Intake in Adolescents

Journal of the American Dietetic Association, 2011