Member, Stanford Cancer Institute
Member, University Committee on Postdoctoral Scholars (2009 - Present)
Honors & Awards
First Independent Research Support and Transition Award (FIRST), National Insitutes of Health, National Heart, Lung, and Blood Institute (1998-2004)
Fellow, North American Association for the Study of Obesity (2001-present)
Divisional Teaching Award, Stanford Prevention Research Center/Department of Medicine (2002, 2007, 2018)
Outstanding Leadership Award, Office of Community Health, Stanford University School of Medicine (2007)
Excellence in Postdoctoral Mentoring Award, Stanford University Postdoctoral Association (2009)
Recognition Award for Extraordinary Service for the Advancement of Postdoctoral Fellows, Stanford University Postdoctoral Association (2012)
Boards, Advisory Committees, Professional Organizations
Consulting Editor, Health Psychology (2017 - Present)
Postdoctoral fellowship, Stanford Prevention Research Center, CVD Epidemiology & Prevention (1997)
PhD, Yale University, Health/Social Psychology (1993)
BA, Washington University in St. Louis, Psychology (1987)
Current Research and Scholarly Interests
For the past 15 years, Dr. Kiernan has conducted research on behavioral weight management at the Stanford Prevention Research Center (SPRC), a Division of the Stanford University Department of Medicine. SPRC is multidisciplinary, focused on research and teaching, and dedicated to the improvement of health through the prevention and effective management of chronic disease influenced by lifestyle behaviors via randomized clinical trials, community intervention studies, and population-based surveys among diverse samples of all ages, ethnic groups, and social strata living in northern Californian communities.
Her research interests include: (1) testing tailored behavioral interventions that promote long-term lifestyle changes and weight management among subgroups at risk; and (2) developing methodological and statistical approaches that improve the design, delivery, and analysis of randomized clinical trials. The latter includes using risk classification methods to better identify subgroups at risk, improving recruitment of ethnic minorities into clinical trials, and clarifying approaches for testing the role of moderators and mediators.
From 2001-2007, Dr. Kiernan was the Research Director of the Scholarly Concentration in Community Health at the Stanford University School of Medicine in which she advised 45+ medical students who conducted individual research projects in collaboration with local and international community health partnerships using mixed methods (qualitative and quantitative) approaches. In 2007, she returned to her primary focus on obesity research, including as PI of the Fresh Start trial (R01 CA112594) designed to test whether learning a set of novel stability skills first (i.e., before losing weight) promotes better long-term maintenance of weight loss than traditional maintenance approaches.
Behavioral Strategies for Weight Management
Although studies demonstrate that people who consistently keep detailed food records are more likely to maintain their weight, few people continue to keep records given the vigilant attention needed. This study will test the efficacy of an alternative approach to record keeping that may be easier for people to sustain and lead to better long-term weight management. We propose that obese adults who attempt to keep their weight within a clearly defined and personalized 'range', e.g., a 5-lb range between 200-205 pounds, will be more likely to continue weighing themselves and remain weight stable because they have learned to self-regulate, i.e., accurately monitor changes in their weight, alert themselves when they've gained too much weight, and 'finetune' their eating and physical activity in response, but with the minimum effort and attention necessary. The primary aim for this randomized trial will examine whether participants in an 8-week 'Fine-Tuning' program are more likely to weigh themselves over the 6-month study than participants in an 8-week traditional 'Record-Keeping' program.
Stanford is currently not accepting patients for this trial. For more information, please contact Michaela Kiernan, (650) 723 - 8460.
Personal Genomics for Preventive Cardiology
The purpose of this study is to see if providing information to a person on their inherited (genetic) risk of cardiovascular disease (CVD) helps to motivate that person to change their diet, lifestyle or medication regimen to alter their risk.
Stanford is currently not accepting patients for this trial. For more information, please contact Josh Knowles, 650-804-2526.
Promoting Healthy Weight With 'Stability Skills First'
Losing weight has many health benefits for women such as reducing the risk of heart attacks, high blood pressure, diabetes, and cancer. However, women often struggle with maintaining the weight they have lost. This may be because they need to learn skills for maintaining weight, not just losing weight. When is the optimal time is to learn these maintenance skills? It may be better to lose weight first and then learn maintenance skills since people may feel good about the weight they have lost and be motivated to maintain. Alternatively, it may be better to learn maintenance skills first and then lose weight since they may experience how easy it is to use these maintenance skills and become confident they can maintain a weight loss in the future. Therefore, this study will examine whether learning these maintenance skills--before or after losing weight--helps women succeed at maintaining weight loss.
Stanford is currently not accepting patients for this trial.
Promoting Long-term Behavior Change to Reduce CVD Risk
Once intervention class or staff contact is removed, obese adults participating in behavioral weight-loss programs often give up healthy eating habits and regain weight. We examined whether taste-based goal setting, which minimizes perceived deprivation by promoting taste and moderation, would sustain long-term reductions in saturated fat and body mass index (BMI).
Stanford is currently not accepting patients for this trial. For more information, please contact Michaela Kiernan, (650) 723 - 8460.
Stanford Healthy Heart Study
People with elevated blood pressure are at higher risk of having a heart attack or stroke than people with lower blood pressure. Losing a modest amount of weight—such as 15 or 20 pounds—can reduce the risk of having a heart attack or stroke. However, it can often be a struggle to maintain weight loss over time. This study examines whether two behavioral weight-management programs can help people maintain weight loss over time. In this study, 346 adults will be randomly assigned (like flipping a coin) to one of the 12-month programs and followed for 36 months (i.e., 3 years) to see how their body weight may change.
Stanford is currently not accepting patients for this trial. For more information, please contact Michaela Kiernan, PhD, 650-721-6684.
- Methods in Community Assessment, Evaluation, and Research
CHPR 247, MED 147, MED 247 (Spr)
Independent Studies (3)
- Community Health and Prevention Research Master's Thesis Writing
CHPR 399 (Aut, Win, Spr)
- Curricular Practical Training and Internship
CHPR 290 (Aut, Win, Spr)
- Directed Reading
CHPR 299 (Aut, Win, Spr, Sum)
- Community Health and Prevention Research Master's Thesis Writing
Prior Year Courses
- Methods in Community Assessment, Evaluation, and Research
CHPR 247, MED 147, MED 247 (Spr)
- Methods in Community Assessment, Evaluation, and Research
CHPR 247, MED 147, MED 247 (Spr)
- Methods in Community Assessment, Evaluation, and Research
CHPR 247, MED 147, MED 247 (Spr)
- Methods in Community Assessment, Evaluation, and Research
The Stanford Leisure-Time Activity Categorical Item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women
INTERNATIONAL JOURNAL OF OBESITY
2013; 37 (12): 1597-1602
Background:Physical activity is essential for chronic disease prevention, yet <40% of overweight/obese adults meet the national activity recommendations. For time-efficient counseling, clinicians need a brief, easy-to-use tool that reliably and validly assesses a full range of activity levels, and, most importantly, is sensitive to clinically meaningful changes in activity. The Stanford Leisure-Time Activity Categorical Item (L-Cat) is a single item comprising six descriptive categories ranging from inactive to very active. This novel methodological approach assesses national activity recommendations as well as multiple clinically relevant categories below and above the recommendations, and incorporates critical methodological principles that enhance psychometrics (reliability, validity and sensitivity to change).Methods:We evaluated the L-Cat's psychometrics among 267 overweight/obese women who were asked to meet the national activity recommendations in a randomized behavioral weight-loss trial.Results:The L-Cat had excellent test-retest reliability (κ=0.64, P<0.001) and adequate concurrent criterion validity; each L-Cat category at 6 months was associated with 1059 more daily pedometer steps (95% CI 712-1407, β=0.38, P<0.001) and 1.9% greater initial weight loss at 6 months (95% CI -2.4 to -1.3, β=-0.38, P<0.001). Of interest, L-Cat categories differentiated from each other in a dose-response gradient for steps and weight loss (Ps<0.05) with excellent face validity. The L-Cat was sensitive to change in response to the trial's activity component. Women increased one L-Cat category at 6 months (M=1.0±1.4, P<0.001); 55.8% met the recommendations at 6 months whereas 20.6% did at baseline (P<0.001). Even among women not meeting the recommendations at both baseline and 6 months (n=106), women who moved 1 L-Cat categories at 6 months lost more weight than those who did not (M=-4.6%, 95% CI -6.7 to -2.5, P<0.001).Conclusions:Given strong psychometrics, the L-Cat has timely potential for clinical use such as tracking activity changes via electronic medical records, especially among overweight/obese populations who are unable or unlikely to reach national recommendations.International Journal of Obesity advance online publication, 16 April 2013; doi:10.1038/ijo.2013.36.
View details for DOI 10.1038/ijo.2013.36
View details for Web of Science ID 000328456200013
View details for PubMedID 23588625
Promoting Healthy Weight With "Stability Skills First": A Randomized Trial
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2013; 81 (2): 336-346
Although behavioral weight-loss interventions produce short-term weight loss, long-term maintenance remains elusive. This randomized trial examined whether learning a novel set of "stability skills" before losing weight improved long-term weight management. Stability skills were designed to optimize individuals' current satisfaction with lifestyle and self-regulatory habits while requiring the minimum effort and attention necessary.Overweight/obese women (N = 267) were randomly assigned to one of two 6-month interventions and assessed at baseline and at 6, 12, and 18 months. Maintenance First women participated first in an 8-week stability skills maintenance module and then in a standard 20-week behavioral weight-loss program. Weight Loss First women participated first in a standard 20-week behavioral weight-loss program and then in a standard 8-week problem-solving skills maintenance module. There was no intervention staff contact during the 12-month follow-up period (6-18 months).As designed, Maintenance First participants lost the same percentage of initial weight during the 6-month intervention period as Weight Loss First participants (M = -8.6%, SD = 5.7, vs. M = -9.1%, SD = 6.9; t = -0.6, p = .52). However, Maintenance First participants regained significantly less weight during the 12-month follow-up period (6-18 months) than Weight Loss First participants (M = 3.2 lb, SD = 10.4, vs. M = 7.3 lb, SD = 9.9 [M = 1.4 kg, SD = 4.7, vs. M = 3.3 kg, SD = 4.5]; t = 3.3, p = .001, d = 0.4).Learning stability skills before losing weight was successful in helping women to maintain weight loss without intervention staff contact during follow-up. These results can inform the study design of future innovative interventions.
View details for DOI 10.1037/a0030544
View details for Web of Science ID 000316908500012
View details for PubMedID 23106759
Innovative techniques to address retention in a behavioral weight-loss trial
24th Annual Meeting of the Society-of-Behavioral-Medicine
OXFORD UNIV PRESS. 2005: 439–47
Given that retention rates for weight-loss trials have not significantly improved in the past 20 years, identifying effective techniques to enhance retention is critical. This paper describes a conceptual and practical advance that may have improved retention in a behavioral weight-loss trial-the novel application of motivational interviewing techniques to diffuse ambivalence during interactive group-based orientation sessions prior to randomization. These orientation sessions addressed ambivalence about making eating and exercise behavior changes, ambivalence about joining a randomized controlled trial, and unrealistic weight-loss expectations. During these sessions, overweight and obese men and women learned about the health benefits of modest weight loss as well as trial design, the importance of a control condition, random assignment and the impact of dropouts. Participants were then divided into groups of three or four, and asked to generate two pros and two cons of being assigned to a control condition and an active condition. Participants shared their pros and cons with the larger group, while the investigator asked open-ended questions, engaged in reflective listening and avoided taking a 'pro-change' position. Retention was high, with 96% of the participants (N = 162) completing 18-month clinic visits.
View details for DOI 10.1093/her/cyg139
View details for Web of Science ID 000230346300006
View details for PubMedID 15598664
Effects of a methodological infographic on research participants' knowledge, transparency, and trust.
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
2018; 37 (8): 782–86
OBJECTIVE: Given participants' research literacy is essential for clinical trial participation, evidence-based strategies are needed that improve literacy and easily accessed online. We tested whether an infographic letter-that illustrated how dropouts can distort study conclusions-improved participant knowledge about the impact of dropouts relative to a control letter.METHOD: In three distinct online samples purposely recruited to assess reproducibility, young ethnically diverse adults were randomized to read an infographic letter or control letter in a hypothetical scenario. Secondary outcomes included participants' perceived transparency of the research organization, perceived value of retention, and perceived trust of the organization. We purposely included two discriminant items, perceived value for the trial outcome and keeping commitments in general, both hypothesized not to change.RESULTS: Across samples, 20% more infographic participants correctly answered how dropouts affected study conclusions than control participants. For example (Experiment 3), nearly 90% of infographic participants correctly answered versus only two thirds of controls (88.7% vs. 66.7%, absolute percentage difference 22.0%, p < .0001). Infographic participants had substantially higher transparency, perceived value for retention, and trust (Cohen's ds = 0.4-1.0, ps < .0001), yet importantly did not value the study outcome or report keeping commitments more than control participants (Cohen's ds = 0.0-0.1, ps > .10).CONCLUSIONS: Promisingly, this transparent, visually powerful methodological infographic improved knowledge and trust. Future trials could embed and experimentally test whether such low-cost online infographics improve not only research literacy, but also trial retention, especially among populations with less initial trust about research. (PsycINFO Database Record
View details for DOI 10.1037/hea0000631
View details for PubMedID 30024233
ATTITUDES TOWARD WEIGHING: LINKING AFFECT, BEHAVIOR, AND WEIGHT IN THE PERINATAL PERIOD
OXFORD UNIV PRESS INC. 2018: S88
View details for Web of Science ID 000431185200200
The Relationship Between the Stanford Leisure-Time Activity Categorical Item and the Godin Leisure-Time Exercise Questionnaire Among Rural Intervention Participants of Varying Health Literacy Status.
Journal of physical activity & health
2018; 15 (4): 269–78
A pragmatic, self-reported physical activity measure is needed for individuals of varying health literacy status.This study is a secondary analysis of a 6-month behavioral intervention for rural Appalachian adults developed using health literacy strategies. We examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline health literacy status moderates intervention effects.Of 301 enrolled participants, 289 completed the L-Cat at baseline and 212 at 6 months. Approximately 33% were low health literate and 43% reported annual income of ≤$14,999. There was high agreement (84.1%) between the L-Cat and adapted GLTEQ for classifying individuals as meeting physical activity recommendations with little differences by health literacy level (low literacy 80.4% and high literacy 85.9%). The primary source of incongruent classification was the adapted GLTEQ classified almost 20% of individuals as meeting recommendations, whereas the L-Cat classified them as not meeting recommendations. There were differences in responsiveness between measures, but baseline health literacy status did not moderate change in any L-Cat or adapted GLTEQ measures.Implications and recommendations for using the L-Cat 2.3 and GLTEQ among individuals of varying health literacy status are discussed.
View details for DOI 10.1123/jpah.2017-0284
View details for PubMedID 29421974
The ASIBS Short Course: A unique strategy for increasing statistical competency of junior investigators in academic medicine.
Journal of clinical and translational science
2017; 1 (4): 235–39
As clinical researchers at academic medical institutions across the United States increasingly manage complex clinical databases and registries, they often lack the statistical expertise to utilize the data for research purposes. This statistical inadequacy prevents junior investigators from disseminating clinical findings in peer-reviewed journals and from obtaining research funding, thereby hindering their potential for promotion. Underrepresented minorities, in particular, confront unique challenges as clinical investigators stemming from a lack of methodologically rigorous research training in their graduate medical education. This creates a ripple effect for them with respect to acquiring full-time appointments, obtaining federal research grants, and promotion to leadership positions in academic medicine. To fill this major gap in the statistical training of junior faculty and fellows, the authors developed the Applied Statistical Independence in Biological Systems (ASIBS) Short Course. The overall goal of ASIBS is to provide formal applied statistical training, via a hybrid distance and in-person learning format, to junior faculty and fellows actively involved in research at US academic medical institutions, with a special emphasis on underrepresented minorities. The authors present an overview of the design and implementation of ASIBS, along with a short-term evaluation of its impact for the first cohort of ASIBS participants.
View details for DOI 10.1017/cts.2017.298
View details for PubMedID 29657857
View details for PubMedCentralID PMC5890315
Applying novel technologies and methods to inform the ontology of self-regulation
Behaviour Research and Therapy
Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.
View details for DOI 10.1016/j.brat.2017.09.014
View details for PubMedCentralID PMC5801197
Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study.
Frontiers in cardiovascular medicine
2017; 4: 53
We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies.We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49) or without (N = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS.Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: -13 vs. -9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry.Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.
View details for PubMedID 28856136
- Putting the brakes on the "drive to eat": Pilot effects of naltrexone and reward-based eating on food cravings among obese women EATING BEHAVIORS 2015; 19: 53-56
Outreach to diversify clinical trial participation: A randomized recruitment study
2015; 12 (3): 205-211
Racial and ethnic minorities remain underrepresented in clinical research, yet few recruitment strategies have been rigorously evaluated.We experimentally tested whether targeted recruitment letters acknowledging diabetes health disparities and health risks specific to recipients' racial/ethnic group improved two metrics of trial participation: willingness to be screened and enrollment. This experiment was efficiently nested within a randomized clinical trial examining a preventive lifestyle intervention among women at high risk for diabetes. Pregnant women with gestational diabetes or impaired glucose tolerance (N = 445) were randomized to receive a targeted recruitment letter with health risk information specific to their racial/ethnic group (n = 216), or a standard letter with risk information for the general population (n = 229). All letters were bilingual in English and Spanish.The targeted as compared to the standard letter did not improve screening or enrollment rates overall or within separate racial/ethnic groups. Among Latina women who preferred Spanish, the targeted letter showed trends for improved screening (66.7% vs 33.3%, p = .06) and enrollment rates (38.9% vs 13.3%, p = .13). In contrast, among Latina women who preferred English, the targeted letter significantly lowered screening (29.6% vs 57.1%, p = .04) and showed trends for lowered enrollment rates (25.9% vs 50.0%, p = .07).Results from this randomized study appear to suggest that recruitment letters with diabetes health risk information targeted to recipients' race/ethnicity may improve one metric of clinical trial participation among Latina women who prefer Spanish, but not English. Larger experimental studies, incorporating input from diverse participant stakeholders, are needed to develop evidence-based minority recruitment strategies.
View details for DOI 10.1177/1740774514568125
View details for Web of Science ID 000353984100003
View details for PubMedID 25644997
View details for PubMedCentralID PMC4424096
Minority recruitment into clinical trials: Experimental findings and practical implications
CONTEMPORARY CLINICAL TRIALS
2012; 33 (4): 620-623
Racial and ethnic minorities in the US suffer disproportionately from obesity and related comorbidities, yet remain underrepresented in health research. To date, research on practical strategies to improve minority reach and recruitment into clinical trials is primarily descriptive rather than experimental. Within a randomized behavioral weight management trial for obese women, this recruitment experiment examined whether two characteristics of direct mail letters, an ethnically-targeted statement and personalization, increased the response rate among minority women. The ethnically-targeted statement noted ethnic-specific information about health risks of obesity. Personalized letters included recipients' names/addresses in the salutation and a handwritten signature on high-quality letterhead. Of women sent direct mail letters (N=30,000), those sent letters with the ethnically-targeted statement were more likely to respond than women sent letters with the generic statement, 0.8% (n=121) vs. 0.6% (n=90) respectively, p=.03, a 34.4% increase. Women sent personalized letters were no more likely to respond than women sent non-personalized letters, p=.53. In the weight management trial itself, of 267 women randomized into the trial, 33.7% (n=90) were minorities. Of minority women randomized into the trial, 68.9% (n=62) were recruited by direct mail letters: 75.8% (n=47) of those were sent a letter and 24.2% (n=15) were referred by friends/family who were sent a letter. The results indicate that a simple modification to a standard recruitment letter can have a meaningful impact on minority reach and recruitment rates. Practical implications include using ethnically-targeted, non-personalized direct mail letters and recruiting through friends/family at no additional cost.
View details for DOI 10.1016/j.cct.2012.03.003
View details for Web of Science ID 000305711700010
View details for PubMedID 22449836
View details for PubMedCentralID PMC3361553
Treatment matching for obesity: identifying mediators of psychosocial and behavioral intervention components.
International journal of obesity supplements
2012; 2: S23-S25
In light of the limited long-term success of obesity treatments, it is tempting to consider the elusive goal of 'treatment matching', in which characteristics of individuals are optimally matched to targeted treatments to improve success. Previous frameworks for treatment matching in obesity have primarily focused on basic physiological characteristics, such as initial degree of overweight, and on treatment intensity, such as stepped-care alternatives (self-help manuals, group support, medication and surgery). Few studies have empirically evaluated the success of these frameworks. Given recent advances in genomics, neuroscience and other fields, both the breadth of domains and combinations of individuals' characteristics that could be used for treatment matching have increased markedly. Although the obesity field seems poised to build on these advances, a crucial challenge remains regarding the treatments themselves. Ultimately, the success of treatment matching will rely on identifying treatment intervention components with well-differentiated and empirically supported mediators, that is, clear insights into how intervention components work. Here we examine the scope of this challenge specifically for the design of efficacious psychosocial and behavioral intervention components, and identify areas for future research.
View details for PubMedID 25089190
View details for PubMedCentralID PMC4109088
- Randomized Trial of Personal Genomics for Preventive Cardiology Design and Challenges CIRCULATION-CARDIOVASCULAR GENETICS 2012; 5 (3): 368-376
Social Support for Healthy Behaviors: Scale Psychometrics and Prediction of Weight Loss Among Women in a Behavioral Program
2012; 20 (4): 756-764
Social support could be a powerful weight-loss treatment moderator or mediator but is rarely assessed. We assessed the psychometric properties, initial levels, and predictive validity of a measure of perceived social support and sabotage from friends and family for healthy eating and physical activity (eight subscales). Overweight/obese women randomized to one of two 6-month, group-based behavioral weight-loss programs (N = 267; mean BMI 32.1 ± 3.5; 66.3% White) completed subscales at baseline, and weight loss was assessed at 6 months. Internal consistency, discriminant validity, and content validity were excellent for support subscales and adequate for sabotage subscales; qualitative responses revealed novel deliberate instances not reflected in current sabotage items. Most women (>75%) "never" or "rarely" experienced support from friends or family. Using nonparametric classification methods, we identified two subscales-support from friends for healthy eating and support from family for physical activity-that predicted three clinically meaningful subgroups who ranged in likelihood of losing ≥5% of initial weight at 6 months. Women who "never" experienced family support were least likely to lose weight (45.7% lost weight) whereas women who experienced both frequent friend and family support were more likely to lose weight (71.6% lost weight). Paradoxically, women who "never" experienced friend support were most likely to lose weight (80.0% lost weight), perhaps because the group-based programs provided support lacking from friendships. Psychometrics for support subscales were excellent; initial support was rare; and the differential roles of friend vs. family support could inform future targeted weight-loss interventions to subgroups at risk.
View details for DOI 10.1038/oby.2011.293
View details for Web of Science ID 000302143300008
View details for PubMedID 21996661
Practices Associated with Weight Loss Versus Weight-Loss Maintenance Results of a National Survey
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
2011; 41 (2): 159-166
Few studies have examined the weight-control practices that promote weight loss and weight-loss maintenance in the same sample.To examine whether the weight control practices associated with weight loss differ from those associated with weight-loss maintenance.Cross-sectional survey of a random sample of 1165 U.S. adults. The adjusted associations of the use of 36 weight-control practices in the past week with success in weight loss (≥10% lost in the past year) and success in weight-loss maintenance (≥10% lost and maintained for ≥1 year) were examined.Of the 36 practices, only 8 (22%) were associated with both weight loss and weight-loss maintenance. Overall, there was poor agreement (kappa=0.22) between the practices associated with weight loss and/or weight-loss maintenance. For example, those who reported more often following a consistent exercise routine or eating plenty of low-fat sources of protein were 1.97 (95% CI=1.33, 2.94) and 1.76 (95% CI=1.25, 2.50) times more likely, respectively, to report weight-loss maintenance but not weight loss. Alternatively, those who reported more often doing different kinds of exercises or planning meals ahead of time were 2.56 (95% CI=1.44, 4.55) and 1.68 (95% CI=1.03, 2.74) times more likely, respectively, to report weight loss but not weight-loss maintenance.Successful weight loss and weight-loss maintenance may require two different sets of practices. Designing interventions with this premise may inform the design of more effective weight-loss maintenance interventions.
View details for DOI 10.1016/j.amepre.2011.04.009
View details for Web of Science ID 000292958900007
View details for PubMedID 21767723
Outcome expectations and realizations as predictors of weight regain among dieters
2011; 12 (1): 60-63
This prospective study tested whether (a) baseline outcome expectations regarding the benefits of a weight-loss diet, (b) 6-month outcome realizations regarding perceived benefits actually experienced, and/or (c) the interaction between them predicted 6-12-month weight regain among overweight/obese women randomized to one of four popular weight-loss diets (N=311). Positive 6-month realizations regarding improvements in physical shape and appearance predicted less 6-12-month weight regain among Atkins diet participants only (n=70), controlling for baseline expectations, the expectations-realization interaction, and initial weight loss. Atkins participants displayed three distinct patterns of regain based on levels of 6-month realizations and initial weight loss. Experimental research should investigate whether improving realizations leads to reduced weight regain in response to this popular diet.
View details for DOI 10.1016/j.eatbeh.2010.08.007
View details for Web of Science ID 000286845700010
View details for PubMedID 21184975
View details for PubMedCentralID PMC3053006
The Jade Ribbon Campaign: A Model Program for Community Outreach and Education to Prevent Liver Cancer in Asian Americans
JOURNAL OF IMMIGRANT AND MINORITY HEALTH
2009; 11 (4): 281-290
The Jade Ribbon Campaign (JRC) is a culturally targeted, community-based outreach program to promote the prevention, early detection, and management of chronic hepatitis B virus (HBV) infection and liver cancer among Asian Americans. In 2001, 476 Chinese American adults from the San Francisco Bay Area attended an HBV screening clinic and educational seminar. The prevalence of chronic HBV infection was 13%; only 8% of participants showed serologic evidence of protective antibody from prior vaccination. Participants reported low preventive action before the clinic, but after one year, 67% of those with chronic HBV infection had consulted a physician for liver cancer screening, and 78% of all participants had encouraged family members to be tested for HBV. The increase in HBV awareness, screening, and physician follow-up suggests that culturally aligned interventions similar to the JRC may help reduce the disproportionate burden of disease to chronic HBV infection among Asian Americans.
View details for DOI 10.1007/s10903-007-9094-2
View details for Web of Science ID 000281505100005
View details for PubMedID 17990118
How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches
2008; 27 (2): S101-S108
In recognition of the increasingly important role of moderators and mediators in clinical research, clear definitions are sought of the two terms to avoid inconsistent, ambiguous, and possibly misleading results across clinical research studies.The criteria used to define moderators and mediators proposed by the Baron & Kenny approach, which have been long used in social/behavioral research, are directly compared to the criteria proposed by the recent MacArthur approach, which modified the Baron & Kenny criteria.After clarifying the differences in criteria between approaches, the rationale for the modifications is clarified and the implications for the design and interpretation of future studies considered.Researchers may find modifications introduced in the MacArthur approach more appropriate to their research objectives, particularly if their research might have a direct influence on decision making.
View details for DOI 10.1037/0278-6133.27.2(Suppl.).S101
View details for Web of Science ID 000254823500002
View details for PubMedID 18377151
View details for PubMedCentralID PMC3376898
Concerns about infertility risks among pediatric oncology patients and their parents
PEDIATRIC BLOOD & CANCER
2008; 50 (1): 85-89
Given pediatric cancer patients are living into adulthood, parents and patients need to be informed about fertility-related side effects of their particular treatment.We surveyed 97 parents of pediatric patients of all ages as well as 37 adolescent patients of 14 years or older who were presented for care at the Lucile Packard Children's Hospital (LPCH) at the Stanford University Medical Center. We estimated the potential infertility risk (low, intermediate, and high) based on the child's treatment regimen.In contrast to our hypothesis, the majority of parents in all three risk categories were concerned about fertility-related side effects of cancer treatment. Many parents with children at low risk were concerned (58.3%) whereas not all parents with children at intermediate or high risk were concerned, 61.5% and 73.3% respectively, P = 0.43. Indeed, over 50% of all parents were erroneously concerned that cancer therapies cause DNA damage to their child's eggs (or sperm). Only 29.9% of parents were satisfied with the amount of information received. Similar patterns were seen among the adolescent patient sample.Parents of pediatric cancer patients and teenage patients have concerns about fertility-related side effects regardless of treatment received. Targeted education about infertility risk before and after treatment can address these gaps.
View details for DOI 10.1002/pbc.21261
View details for Web of Science ID 000251410400015
View details for PubMedID 17514741
Use of a community mobile health van to increase early access to prenatal care
MATERNAL AND CHILD HEALTH JOURNAL
2007; 11 (3): 235-239
To examine whether the use of a community mobile health van (the Lucile Packard Childrens Hospital Women's Health Van) in an underserved population allows for earlier access to prenatal care and increased rate of adequate prenatal care, as compared to prenatal care initiated in community clinics.We studied 108 patients who initiated prenatal care on the van and delivered their babies at our University Hospital from September 1999 to July 2004. One hundred and twenty-seven patients who initiated prenatal care in sites other than the Women's Health Van, had the same city of residence and source of payment as the study group, and also delivered their babies at our hospital during the same time period, were selected as the comparison group. Gestational age at which prenatal care was initiated and the adequacy of prenatal care - as defined by Revised Graduated Index of Prenatal Care Utilization (RGINDEX) - were compared between cases and comparisons.Underserved women utilizing the van services for prenatal care initiated care three weeks earlier than women using other services (10.2 +/- 6.9 weeks vs. 13.2 +/- 6.9 weeks, P = 0.001). In addition, the data showed that van patients and non-van patients were equally likely to receive adequate prenatal care as defined by R-GINDEX (P = 0.125).Women who initiated prenatal care on the Women's Health Van achieved earlier access to prenatal care when compared to women initiating care at other community health clinics.
View details for DOI 10.1007/s10995-006-0174-z
View details for Web of Science ID 000246578900005
View details for PubMedID 17243022
Image-guided robotic radiosurgery for spinal metastases
RADIOTHERAPY AND ONCOLOGY
2007; 82 (2): 185-190
To determine the effectiveness and safety of image-guided robotic radiosurgery for spinal metastases.From 1996 to 2005, 74 patients with 102 spinal metastases were treated using the CyberKnife at Stanford University. Sixty-two (84%) patients were symptomatic. Seventy-four percent (50/68) of previously treated patients had prior radiation. Using the CyberKnife, 16-25 Gy in 1-5 fractions was delivered. Patients were followed clinically and radiographically for at least 3 months or until death.With mean follow-up of 9 months (range 0-33 months), 36 patients were alive and 38 were dead at last follow-up. No death was treatment related. Eighty-four (84%) percent of symptomatic patients experienced improvement or resolution of symptoms after treatment. Three patients developed treatment-related spinal injury. Analysis of dose-volume parameters and clinical parameters failed to identify predictors of spinal cord injury.Robotic radiosurgery is effective and generally safe for spinal metastases even in previously irradiated patients.
View details for DOI 10.1016/j.radonc.2006.11.023
View details for Web of Science ID 000245151400011
View details for PubMedID 17257702
Attitudes and practices of pediatric oncology providers regarding fertility issues
PEDIATRIC BLOOD & CANCER
2007; 48 (1): 80-85
Given the higher survival rates of childhood cancer, health care providers must be aware of the side effects of cancer therapies to educate patients and provide appropriate interventions to reduce cancer-related morbidity. To understand the current practices and attitudes in a pediatric hematology/oncology clinic, health care providers were surveyed regarding fertility issues pertinent to their patient care. PARTICIPANTS AND INSTRUMENTS: In this study, 93.8% (30/32) health care providers in one pediatric hematology/oncology department completed a 44-item survey assessing knowledge, current practices, obstacles to current practices, perceptions of patient differences, and improvements to future practice.The majority of health care providers were aware of the adverse effects of alkylating agents (90.7%) and of abdominal and pelvic radiation (100.0%) on fertility. However, only half were aware of gender differences in gonadotoxicity (50.0%) or knowledgeable of current research and technology in fertility preservation (53.3%). While only 34.6% of providers currently consulted with specialists, nearly all (92.8%) indicated a desire to do so in the future, but 64.3% indicated difficulties in finding proper facilities and specialists for their patients. Almost all (96.6%) agreed that providers and patient families need more information regarding the effects of cancer therapy on fertility.Surveyed pediatric oncology providers considered fertility to be an important issue for childhood cancer patients and desired more resources regarding effects on fertility and fertility preservation. Greater communication needs to be established between pediatric oncology providers and specialists in reproductive medicine and endocrinology to ensure adequate professional collaboration and patient referrals.
View details for DOI 10.1002/pbc.20814
View details for Web of Science ID 000242425000015
View details for PubMedID 16572406
Characteristics of pediatric patients at risk of poor emergency department aftercare
ACADEMIC EMERGENCY MEDICINE
2006; 13 (8): 840-847
To identify and characterize subgroups of a pediatric population at risk of poor emergency department (ED) aftercare compliance.This was a prospective, cohort study conducted at a university hospital ED with a 2003 pediatric census of 11,040 patients. A convenience sample of 461 children was enrolled. The study follow-up rate was 97%. The primary outcomes were guardian compliance with instructions for physician follow-up appointment and with obtaining prescribed medications. Predictors of compliance outcomes were analyzed by using recursive partitioning to describe population subgroups at risk of poor compliance.Only 60.4% of patient guardians followed up with instructions to see a physician. Children with private insurance were more likely to follow up than were children without private insurance (76.8% vs. 46.5%, p < 0.001). Of children with private insurance, those with high-acuity diagnoses were more likely to follow up than were patients with low-acuity diagnoses (80.0% vs. 38.5%, p < 0.001). Of children who were considered underinsured (defined as publicly insured or uninsured), those with English-speaking guardians were more likely to follow up than were those with non-English-speaking guardians (58.0% vs. 40.0%, p < 0.05). Only 63.3% of patient guardians obtained prescribed medications. Privately insured children were more likely to obtain medications than were underinsured children (71.0% vs. 58.0%, p < 0.05). Descriptive profiles of the subgroups revealed that those with lower socioeconomic status were at greatest risk of poor aftercare compliance.Compliance with ED aftercare instructions remains a challenge. Health insurance disparities are associated with poor ED aftercare compliance in our pediatric population. Interventions aimed at improving compliance could be targeted to specific subgroups on the basis of their descriptive profiles.
View details for DOI 10.1197/j.aem.2006.04.021
View details for PubMedID 16880500
Sentinel lymph node biopsy for cutaneous melanoma - The Stanford experience, 1997-2004
ARCHIVES OF DERMATOLOGY
2005; 141 (8): 1016-1022
To review sentinel lymph node (SLN) data from Stanford University Medical Center from January 1, 1997, to January 1, 2004, including rates of SLN positivity according to 2002 American Joint Committee on Cancer (AJCC) tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence.Retrospective case series.Stanford University Medical Center and Stanford melanoma clinics.A total of 274 consecutive patients with primary melanoma who underwent SLN biopsy (SLNB) between January 1, 1997, and January 1, 2004, or who were referred to the Stanford melanoma clinics after SLNB and were followed up through March 2005.All patients underwent standard wide local excision of their primary tumors and SLNB with intradermal injection of isosulfan blue dye and/or technetium sulfur colloid.Rates of SLN positivity per 2002 AJCC tumor classification, relation to other clinical and pathologic prognostic factors, and rates and sites of melanoma recurrence in node-negative and node-positive patients.Positive SLNs were detected in 39 (15%) of 260 cases, including 0 (0%) of 45 for cutaneous melanomas 1.0 mm thick or less (T1), 21 (18%) of 115 for melanomas 1.01 to 2.0 mm thick (T2), 12 (19%) of 64 for melanomas 2.01 to 4.0 mm thick (T3), and 5 (16%) of 32 for melanomas thicker than 4.0 mm (T4). Median Breslow depths were 1.89 mm for SLN-positive biopsy specimens and 1.50 mm for SLN-negative biopsy specimens (P = .07). The recurrence rate was 46% among SLN-positive patients, with a median time to recurrence of 8 months. Bivariate analysis revealed SLN positivity to be associated with AJCC tumor classification (P = .02), location on the trunk (P = .03), and presence of ulceration (P = .03). By multivariate logistic regression, ulceration (P = .01) was predictive of SLN positivity, whereas SLN status (P< .001), ulceration (P = .02), and location (P = .03) were predictive of recurrent disease.Data from the past 8 years confirm the accuracy and prognostic value of SLNB in cutaneous melanoma and the low rate of regional nodal recurrence for SLN-negative patients.
View details for PubMedID 16103331
- Is a Web survey as effective as a mail survey? A field experiment among computer users AMERICAN JOURNAL OF EVALUATION 2005; 26 (2): 245-252
- Physical activity as a nonpharmacological treatment for depression: A review Complementary Health Practice Review 2003; 8: 139-152
Men gain additional psychological benefits by adding exercise to a weight-loss program
2001; 9 (12): 770-777
Adding exercise to a comprehensive weight-loss program might not only attenuate any psychological distress associated with weight-loss attempts but also may provide psychological benefits. This study examined whether a diet-plus-exercise weight-loss program improved psychological outcomes more than a diet-only weight-loss program or an assessment-only control group.This study was part of a larger 1-year randomized weight-loss trial examining the effects of diet and exercise on cardiovascular disease risk factors in 264 overweight adults. Psychological measures specific to weight control (e.g., cognitive restraint, disinhibition, hunger, and body dissatisfaction) as well as traditional measures of psychological distress (e.g., symptoms of depression, anxiety, and stress) were obtained at baseline and 1 year.Men and women in either weight-loss program reported greater restraint, less disinhibition, and less hunger at 1 year than those in no program. Men in the diet-plus-exercise program experienced additional increases in restraint and decreases in hunger than did men in the diet-only program. Women in the diet-plus-exercise program did not experience additional psychological benefits specific to weight control than those in the diet-only program, despite increases in aerobic capacity.The pattern seen for overweight men in the diet-plus-exercise program at 1 year-greater restraint, less disinhibition, and less hunger-is similar to the pattern seen in successful weight maintainers. These results underscore the need for innovative strategies that will enhance and sustain the pattern of psychological benefits specific to weight control associated with successful weight loss, especially for overweight women.
View details for Web of Science ID 000172892000006
View details for PubMedID 11743061
Is parental control over children's eating associated with childhood obesity? Results from a population-based sample of third graders
2001; 9 (5): 306-312
Identifying parental behaviors that influence childhood obesity is critical for the development of effective prevention and treatment programs. Findings from a prior laboratory study suggest that parents who impose control over their children's eating may interfere with their children's ability to regulate intake, potentially resulting in overweight. These findings have been widely endorsed; however, the direct relationship between parental control of children's intake and their children's degree of overweight has not been shown in a generalized sample.This study surveyed 792 third-grade children with diverse ethnic and socioeconomic backgrounds from 13 public elementary schools. Parental control over children's intake was assessed through telephone interviews using a state-of-the-art instrument, and children were measured for height, weight, and triceps skinfold thickness.Counter to the hypothesis, parental control over children's intake was inversely associated with overweight in girls, as measured by body mass index, r = -0.12, p < 0.05, and triceps skinfolds, r = -0.11, p < 0.05. This weak relationship became only marginally significant when controlling for parents' perceptions of their own weight, level of household education, and children's age. No relationship between parental control of children's intake and their children's degree of overweight was found in boys.Previous observations of the influence of parental control over children's intake in middle-class white families did not generalize to 8- to 9-year-olds in families with diverse socioeconomic and ethnic backgrounds. The present findings reveal a more complex relationship between parental behaviors and children's weight status.
View details for Web of Science ID 000168685300005
View details for PubMedID 11346672
Do logistic regression and signal detection identify different subgroups at risk? Implications for the design of tailored interventions
2001; 6 (1): 35-48
Identifying subgroups of high-risk individuals can lead to the development of tailored interventions for those subgroups. This study compared two multivariate statistical methods (logistic regression and signal detection) and evaluated their ability to identify subgroups at risk. The methods identified similar risk predictors and had similar predictive accuracy in exploratory and validation samples. However, the 2 methods did not classify individuals into the same subgroups. Within subgroups, logistic regression identified individuals that were homogeneous in outcome but heterogeneous in risk predictors. In contrast, signal detection identified individuals that were homogeneous in both outcome and risk predictors. Because of the ability to identify homogeneous subgroups, signal detection may be more useful than logistic regression for designing distinct tailored interventions for subgroups of high-risk individuals.
View details for DOI 10.1037//1082-989X.6.1.35
View details for Web of Science ID 000170728000004
View details for PubMedID 11285811
Methodologic issues in measuring physical activity and physical fitness when evaluating the role of dietary supplements for physically active people
Workshop on Role of Dietary Supplements for Physically Active People
AMER SOC CLINICAL NUTRITION. 2000: 541S–550S
Physical activity and physical fitness are complex entities comprising numerous diverse components that present a challenge in terms of accurate, reliable measurement. Physical activity can be classified by its mechanical (static or dynamic) or metabolic (aerobic or anaerobic) characteristics and its intensity (absolute or relative to the person's capacity). Habitual physical activity can be assessed by using a variety of questionnaires, diaries, or logs and by monitoring body movement or physiologic responses. Selection of a measurement method depends on the purpose of the evaluation, the nature of the study population, and the resources available. The various components of physical fitness can be assessed accurately in the laboratory and, in many cases, in the field by using a composite of performance tests. Most coaches and high-level athletes would accept as very beneficial a dietary supplement that would increase performance in a competitive event by even 3%; for example, lowering a runner's time of 3 min, 43 s in the 1500 m by 6.7 s. To establish that such small changes are caused by the dietary supplement requires carefully conducted research that involves randomized, placebo-controlled, double-blind studies designed to maximize statistical power. Statistical power can be increased by enlarging sample size, selecting tests with high reliability, selecting a potent but safe supplement, and maximizing adherence. Failure to design studies with adequate statistical power will produce results that are unreliable and will increase the likelihood that a true effect will be missed.
View details for Web of Science ID 000088634200009
View details for PubMedID 10919958
Identifying patients for weight-loss treatment - An empirical evaluation of the NHLBI obesity education initiative expert panel treatment recommendations
ARCHIVES OF INTERNAL MEDICINE
2000; 160 (14): 2169-2176
The NHLBI (National Heart, Lung, and Blood Institute) Obesity Education Initiative Expert Panel recently proposed that clinicians and other health care professionals use a new treatment algorithm to identify patients for weight-loss treatment. In addition to the usual assessment of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), the new algorithm includes the assessment of abdominal obesity (as measured by waist circumference) and other cardiovascular disease (CVD) risk factors.We examined the percentage of adults meeting the criteria of the panel's treatment algorithm: BMI > or =30 or ¿[BMI, 25.0-29.9 or waist circumference >88 cm (women) >102 cm (men)] and > or = 2 CVD risk factors¿ in a sample of 2844 black, 2754 Mexican American, and 3504 white adults, aged 25 to 64 years, from the Third National Health and Nutrition Examination Survey, 1988-1994.Across ethnic groups, more than 98% of adults (normal weight, overweight, and obese) received the same treatment recommendations using the panel's algorithm and an algorithm based only on BMI and CVD risk factors, without waist circumference. For normal-weight adults, almost none (0.0%-1.8%) had a large waist circumference as defined above and 2 or more CVD risk factors. Using the usual criterion of a BMI of 30 or higher, a substantial percentage of at-risk overweight women and men (BMI, 25.0-29.9) with 2 or more CVD risk factors were missed (8.4% and 19.3%, respectively).Despite the potential importance of abdominal obesity as a CVD risk factor, these results challenge the clinical utility of including waist circumference in this new algorithm and suggest that using BMI and CVD risk factors may be sufficient.
View details for Web of Science ID 000088233300013
View details for PubMedID 10904460
Using direct mail to recruit hispanic adults into a dietary intervention: An experimental study
ANNALS OF BEHAVIORAL MEDICINE
2000; 22 (1): 89-93
Identifying strategies for successful recruitment of ethnic minorities into scientific studies is critical. Without effective methods, investigators may fail to recruit the desired sample size, take longer to recruit than planned, and delay progress for research in minority health. Direct mail is an appealing recruitment method because of the potential for reaching large target populations and producing a high volume of inquiries about a study with relatively little staff effort. To determine which of three direct mail strategies yielded higher recruitment, 561 Hispanic employees were randomly assigned to receive either: (a) a flyer about a worksite dietary intervention; (b) the same flyer plus a personalized hand-signed letter containing heart disease risk statistics for the general American population; or (c) the flyer plus a personalized hand-signed letter containing statistics for Hispanics. Two orthogonal chi-square comparisons were examined. The personalized letters plus flyer yielded a significantly higher response rate (7.8%) than the flyer alone (2.1%), X2(1, N = 561) = 7.5, p = .006. However, the personalized letter with Hispanic heart disease risk statistics did not yield a statistically significant higher response rate (9.1%) than the letter with the general population risk statistics (6.5%), X2(1, N = 370) = 0.9, p > .34. These findings suggest that personalized approaches can increase the effectiveness of direct mail efforts for recruiting ethnic minorities into interventions and may be particularly helpful for large-scale interventions.
View details for Web of Science ID 000088802800011
View details for PubMedID 10892533
The effects of marital transitions on changes in physical activity: Results from a 10-year community study
ANNALS OF BEHAVIORAL MEDICINE
1998; 20 (2): 64-69
The potential effects of making a marital transition on subsequent physical activity were evaluated across a ten-year period in a population-based sample of 302 women and 256 men ages 25 to 75 years. Subjects completed a structured interview at five timepoints throughout the ten-year period during which they reported on their physical activity level as well as marital status. The transition from a married to a single state did not affect physical activity relative to remaining married when analyses of either slopes or mean values were used. In contrast, the transition from a single to a married state resulted in significant positive changes in physical activity relative to remaining single throughout the study period when physical activity slopes, though not means, were compared. The results suggest that marriage may potentially set the stage for natural changes in physical activity that could be capitalized on through appropriate intervention, but additional research is needed to verify this in light of the inconsistent pattern of findings.
View details for Web of Science ID 000078467900003
View details for PubMedID 9989310
Characteristics of successful and unsuccessful dieters: An application of signal detection methodology
ANNALS OF BEHAVIORAL MEDICINE
1998; 20 (1): 1-6
Signal detection methods were used to identify predictors of successful weight loss in 177 mildly to moderately overweight women and men assigned to one of two weight-loss programs. Predictors included initial demographic, physiological, behavioral, and psychosocial characteristics, and program type (e.g. diet-only and diet-plus-exercise). Successful weight loss was defined as a loss of at least two units of body mass index at one year. Four subgroups were identified. Participants in the diet-plus-exercise program who were initially more satisfied with their bodies and did not have a history of repeated weight loss were most likely to succeed (63% succeeded). In contrast, participants assigned to the diet-plus-exercise program who were either extremely dissatisfied with their bodies or who had a history of repeated weight loss were at similar risk for failure as participants in the diet-only program (only 26% to 35% succeeded). The results underscore the potential utility of exploring these subgroups further to inform the development of new treatment strategies to increase the likelihood of success.
View details for Web of Science ID 000075741800001
View details for PubMedID 9755345
Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making
1997; 16 (4): 380-389
Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.
View details for Web of Science ID A1997XJ90600011
View details for PubMedID 9237091
RELATION OF LEVEL OF EXERCISE, AGE, AND WEIGHT-CYCLING HISTORY TO WEIGHT AND EATING CONCERNS IN MALE AND FEMALE RUNNERS
1992; 11 (6): 418-421
We examined the association between level of exercise and degree of weight preoccupation in a large sample of male and female runners, as well as risk factors posited to influence weight and eating concerns in the general population. Subjects were 2,459 males and 1,786 females who had completed a questionnaire on weight and eating concerns in a national running magazine. Eight percent of the males and 24% of the females had symptomatic scores on the Eating Attitudes Test (EAT). Exercise level, defined as weekly running mileage, was positively associated with excessive weight and eating concerns in males but not in females. Both sexes with a history of weight cycling were more likely to have symptomatic EAT scores than those with no such history. These results highlight the importance of studying these concerns in males as well as females and of examining the role of exercise level and weight-cycling history in the development of serious weight preoccupations.
View details for Web of Science ID A1992KL03300011
View details for PubMedID 1286662