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In today's rapidly changing health care environment, it is imperative that dietitians demonstrate the importance of their role as health care providers by initiating and participating in outcomes research. Patient care should be based on empirical studies, and clinical dietitians should participate in or be at the helm of such investigations. Nutrition research is usually accomplished and reported by persons with MD or PhD degrees who do not have clinical training in nutrition and does not often address situations encountered by dietitians in clinical settings. This article examines the extent to which clinical dietitians are conducting and reporting outcomes research, their attitudes about such research, and how they think they could best acquire the skills needed to incorporate outcomes research into their practice. Results indicate that clinical dietitians are not writing a substantial percentage of articles and that reports of outcomes research are not commonly included in clinical nutrition journals. Clinical dietitians appear to value the inclusion of research in clinical practice, but they are not spending a great amount of time doing research. Dietitians report being comfortable about participating in research but not about designing, conducting, and reporting research. Results from several surveys were used to develop a model for integrating research in clinical practice. This model includes the research process as a basis for clinical practice. A model for collaborative efforts between clinical and academic dietitians is also proposed and emphasizes the responsibility of academic dietetics training programs in the integration of research and clinical practice.

The purpose of this study was to determine whether a history of depression in female smokers (age 18-65) who did not self-report any current depression was associated with adherence to a multisession, multicomponent smoking-cessation program. Participants in a 13-week cognitive-behavioral group program plus random assignment to nicotine gum, appetite suppressant gum, or placebo chewing gum were grouped by depressive-history and compared on attendance, average expired carbon monoxide after planned cessation, and number of pieces of gum chewed. No significant differences between the depressive history (yes/no) subgroups were found on any of the three measures of adherence. The power to detect a significant difference (alpha = 0.05) was calculated to be 0.89. Group cognitive-behavioral treatment appears to be the basis of an effective smoking-cessation program for women with a history of depression who are not currently depressed.

Forty women smokers were randomly assigned to smoking cessation for a 10-day period of time, either during the follicular or the luteal phase of their menstrual cycle. Measurements of dietary intake and body weight were collected during the same phase the previous (smoking as usual) month and during the cessation phase. Physical activity was controlled across the 2 months. Comparisons between the smoking and cessation months indicated that both groups increased their dietary intake during the cessation month, but no interaction occurred between phase and month. That is, women in both groups increased dietary intake to the same degree. All energy nutrients tested (fat, complex carbohydrates, and sugar) increased significantly from baseline to cessation. Conversely, body weight increased by 1.8 kg (4 lb) in the Luteal group, while weight remained stable (0.1 kg change) in the Follicular group.

Participants in an 8-session, community based smoking cessation intervention rated whether they would stay quit if they experienced weight gain. The majority reported that they would not relapse to smoking, even after a 20-lb, (9.07-kg) weight gain. Those who were weight concerned were more likely to be female, to weight less and be normal or underweight, and to report chronic dieting. This group was also significantly less likely to be abstinent posttreatment, and at the 1-, 6- and 12-month follow-ups. Individuals presenting for formal smoking cessation interventions may be less weight concerned than the general population of smokers. However, weight-concerned smokers who do present for treatment are less likely to quit smoking. Implications for recruitment and intervention are discussed.

Estimates of postcessation weight gain vary widely. This study determined the magnitude of weight gain in a cohort using both point prevalence and continuous abstinence criteria for cessation. Participants were 196 volunteers who participated in a smoking cessation program and who either continuously smoked (n = 118), were continuously abstinent (n = 51), or who were point prevalent abstinent (n = 27) (i.e., quit at the 1-year follow-up visit but not at others). Continuously abstinent participants gained over 13 lbs. (5.90 kg) at 1 year, significantly more than continuously smoking (M = 2.4 lb.) and point prevalent abstinent participants (M = 6.7 lbs., or 3.04 kg). Individual growth curve analysis confirmed that weight gain and the rate of weight gain (pounds per month) were greater among continuously smoking participants and that these effects were independent of gender, baseline weight, smoking and dieting history, age, and education. Results suggest that studies using point prevalence abstinence to estimate postcessation weight gain may be underestimating postcessation weight gain.

Two widely used food frequency questionnaires (Block FFQ, Willett FFQ) were modified to reflect intake over the past 7 days and compared to intake information gathered from diet records and 24-hr recalls covering the same 7-day period. The Block FFQ and the Willett FFQ were also gathered at the beginning of the assessment period to reflect the 7-day period of time before records and recalls were gathered. Fifty-six subjects were assigned to either recording diet for 3 days, recording diet for 6 days, or providing three 24-hr recalls. Results indicate similar levels of within-method test-retest reliabilities for 3-day RECORDS and 6-day RECORDS, and within the two Block FFQs and within the two Willett FFQs from each subject, while lower reliabilities were seen in 24-hr RECALLS. When the FFQs were compared to the 6-day RECORDS with between-method agreement coefficients, there was a moderate level of agreement, with most values between 0.5 and 0.8 for both FFQs. Significant differences between mean levels of nutrients estimated by the three methods indicated differences only in the estimates of carbohydrate and vitamin A. The use of FFQs to gather short-term intake information is discussed.

Objective: To identify predictors of a change in waist circumference in a group of healthy young adults., Subjects: Caucasian, 121 women and 109 men, participating in a longitudinal investigation of cardiovascular risk factors in parents and their young children., Measurements: Evaluations of body weight, waist and hip circumferences, dietary intake, physical activity, cigarette smoking, and alcohol intake were performed annually. Age was recorded and family history of disease was assessed., Results: For women, covariates and modifiable predictors accounted for 67% of the variance in waist circumference change from Year 1 to Year 3. Women with lower baseline waist girths, lower baseline hip girths, higher baseline body weight, and a greater change in body weight had larger increases in waist girth. For men, covariates and modifiable predictors accounted for 72% of the variance in waist circumference change. Men with lower baseline waist girth, a greater change in hip girth, higher baseline body weight, greater increases in body weight, and less percent of fat in the diet at baseline had larger increases in waist girth. Other non-modifiable variables did not predict change in either gender., Conclusion: Reducing excess body weight and decreasing weight gain appear to be the most important factors in preventing the accumulation of upper body fat.

The present study sought to identify the presence and degree of apparent underreporting of dietary intake in 11,663 participants in the Second National Health and Nutrition Examination Survey (NHANES II). Self-reported dietary intake was compared with estimated basal metabolic rate. Underreporting was based on cutoff limits that identified plausible levels of energy expenditure for adult individuals. Results indicated that up to 31% of adults in this sample may have underreported dietary intake. Those individuals at greatest risk of underreporting were less well educated and heavier. The Sex x Race interaction indicated that for both ethnic categories, women were more likely to underreport than men, but the difference between men and women was greater among Caucasian participants. It is concluded that such factors as reduced energy needs, deliberate falsification, and measurement error inherent in dietary assessment contribute to apparent underreporting, and this occurs in a large percentage of dietary data.

The aim of this work was to assess the accuracy of physicians' subjective assessments of obesity status. The subjects were participants in The Second National Health and Nutrition Examination (NHANES II) Survey. The physicians' subjective judgments of obesity were compared to BMI, an objective measure of actual body mass. Subjects with a body mass index (BMI = weight in kg/(height in cm/100)2) less than or equal to 27.5 were classified as normal weight and those with a BMI greater than or equal to 30.4 were considered to be obese. Physicians were accurate in their diagnosis of the normal weight group with only 4.03% being misdiagnosed as obese. However, 12.6% of the obese group was misdiagnosed as normal weight. The odds of an incorrect normal weight diagnosis increased with age. Similarly, as the fat distribution ratio increased, i.e., a more central pattern, the odds of being actually obese but incorrectly diagnosed as normal weight increased. Men were more likely than women to be incorrectly diagnosed as normal weight. Non-Caucasian normal weight persons appear to have been diagnosed more stringently than Caucasians as they were more likely to be misdiagnosed as obese regardless of their gender. There appear to be several variables affecting the physicians' subjective assessment of obesity status in this data set.

This study examined whether preschool children differed on measures of psychosocial functioning both cross-sectionally and longitudinally. One hundred and thirty-two children who varied in levels of body fat participated in the study along with their natural parents. Results indicated that the children did not differ in levels of self-esteem and family functioning as a function of their body fat. Prospectively, physical self-esteem weakly (but significantly) correlated with body fat at 1 and 2 years, and father's perception of family functioning predicted body fat at 1 year only. Results suggested that childhood obesity may not develop as a result of psychosocial factors.

In a prospective study, we evaluated familial aggregation of blood pressure in a sample of 175 normotensive families with children 3 to 6 yr old. Systolic and diastolic blood pressure measurements of parents and children were correlated at 1, 2, and 3 yr intervals. Spearman rank-order correlation coefficients between parents and children were significant for mother-son pairs. In particular, mother-son blood pressure correlation coefficients were significant for systolic blood pressure across all 3 yr and for diastolic blood pressure during yr 2. Further analyses were performed adjusting for body mass index (BMI), age, physical activity, sodium intake, potassium intake, and parental smoking status, and alcohol use. The Spearman correlation coefficients for mother-son pairs remained significant for yr 1 and 3 after adjusting for these blood pressure correlates. These results are consistent with cross-sectional studies and suggest that both genetic and environmental contributions to blood pressure status are important in young children.

Methods: Data from the NHANES II survey were used to determine whether the calcium intake of children ages 3-18 met the minimum recommended daily allowance. In addition, the impact of age, race, sex, and socioeconomic status on calcium intake and the density of calcium intake was explored., Results: The results indicated significant differences between groups of children based on age, sex, and race (P less than 0.05). Males across all age groups (3-5, 6-7, 8-10, 11-12, 13-18) had a higher calcium intake than females. In addition, calcium intake levels among males always met or exceeded the minimum RDA. Levels among all blacks started below the minimum RDA in the age group 3-5. During the adolescent years, calcium intake again fell below the RDA for black males and for females of both races, with the calcium intake of the adolescent females resembling that of the group ages 3-5. In a multiple regression model sex, age, race, and total energy intake predicted 49% (P less than 0.0001) of the variance in calcium intake. Socioeconomic status (using parents' reported income) was not a significant predictor. Another regression model was used to examine the relationship among age, race, sex, and socioeconomic status and its effect on the density of calcium intake (mg/kcal). While the overall model was significant (P less than 0.0001) it accounted for only 3.5% of the variance., Conclusion: Age, sex, and race of the child significantly predicted the density of calcium (P less than 0.05); however, parents' gross income did not (P less than 0.81), indicating that income level does not contribute to explaining these differences.

A large cohort of children was divided into two groups based on their parents' weight status. The high risk group had one or two overweight parent(s) (n = 92, 4.4 +/- 0.5 years), while the low risk group had no parent overweight (n = 95, 4.5 +/- 0.5 years). Weight of the two groups was similar at the start of the study but the high risk group gained marginally more weight over a one year period (P = 0.05). Although total energy intake was similar, the high risk group was consuming a larger percentage of energy from fat (P = 0.0004) and a smaller percentage from carbohydrate (P = 0.0002). Observed physical activity as similar for most levels but marginally higher for the stationary level and marginally lower in total activity in the high risk group. These results suggest a pattern that may lead to increased weight gain in a high risk group as they grow older.

This study evaluates the longitudinal relationships among smoking and adiposity, dietary intake, and physical activity in a group of adult males. Subjects were 101 nonsmokers and 19 regular cigarette smokers. Adiposity, dietary intake, and physical activity were assessed annually for three consecutive years. Results indicated that nonsmokers had larger tricep skinfold measurements than smokers over the 3-year period. However, dietary intake and physical activity did not differ between groups. Due to the absence of differences on these two variables for the smoking and nonsmoking groups, it was concluded that the lower adiposity in smokers was largely metabolically determined, which may make difficult the treatment of postcessation weight gain.

Quantifying dietary intake remains a challenge. Although advances have been made, we are still attempting to find a quick yet reliable intake method. Utilizing brief, frequency-type questionnaires that have already been tested is an attractive option. However, many of us would also like to alter those questionnaires to make them more specific to our study population. The items covered in this article should help to illuminate some of the tissues that must be considered.

Measures typically used to assess short-term intake are 24-hour recalls or records of food intake. However, these methods require a large time commitment from both researchers and subjects. Our study sought to develop a more time-efficient method of assessing short-term intake by developing a 7-day food frequency questionnaire (7DFFQ). We modified Willett's 1-year food frequency questionnaire to assess intake for a 7-day period. Content validity has previously been exhibited in Willett's work. We assessed criterion validity by comparing the 7DFFQ with 24-hour recalls. Twenty-one female and 20 male college students were asked to recall their previous day's intake three times during a 1-week period. After the last recall, subjects completed a 7DFFQ covering the same week. Data were analyzed by comparing each recall and the mean of the three recalls with values obtained on the 7DFFQ. Analyses revealed high correlations between the mean of the three recalls and the 7DFFQ. Further analysis ranked subjects into quartiles for each nutrient on both measures. Most subjects changed either no quartiles or only one quartile for total energy and each nutrient. Test/retest reliability was assessed by administering the 7DFFQ to a group of women for two consecutive weeks and by administering the 7DFFQ to a group twice 3 hours apart. Pearson's r and intraclass correlations for the two administrations show moderately high reliability over the 1-week period and considerable improvement with the 3-hour administration. The 7DFFQ appears to meet several of the criteria for a measure of dietary intake.

The purpose of the current investigation was to evaluate, using multiple measures of physical activity, the relationships among physical activity, body composition, resting heart rate, and blood pressure in an adult population. Subjects were 221 male (135 normal weight, 86 overweight) and 221 female (156 normal weight, 65 overweight) subjects participating in a longitudinal study of cardiovascular risk factors in families. All subjects were administered three physical activity questionnaires. Principal components analyses were conducted to reduce measures into empirically derived subscales; this analysis revealed five stable factors in men and four in women. Results indicated that aerobic/leisure time significantly correlated to body composition and resting heart rate in both men and women. Additionally, aerobic/leisure time activity was related to blood pressure in women, and moderate activity was related positively to blood pressure in men. No other form of activity (e.g., light activity, anaerobic activity) was related to either adiposity or blood pressure. The implications of these results are discussed, and future research directions are highlighted.

This investigation determined the accuracy of self-reports of physical activity compared to observations obtained surreptitiously. Subjects were 44 adults engaged in 1 h of their preferred physical activity while actual activity levels were surreptitiously obtained and compared to immediate self-reported estimates of physical activity. Results indicated that subjects were moderately accurate in recalling their physical activity levels (R = 0.62) but underestimated sedentary activities and overestimated aerobic activities by over 300%. Males overestimated their activity relative to females, and obese subjects underestimated their activity levels compared to normal-weight subjects. Finally, a number of two-way interactions that moderated the accuracy of those subjects engaging in high chronic levels of physical activity were observed.

This investigation examined the relationships among measures of childhood physical activity and their association with measures of weight and blood pressure in a sample (n = 222) of preschool children. A multimethod factored approach to the assessment of physical activity was used; this approach included direct observation, motion sensor evaluation, and several parental reports of the subjects' activity levels. Analysis of these data revealed three highly significant activity factors: general activity, hyperactivity, and direct-observation-competitiveness activity. When the association between physical activity factors and cardiovascular risk was explored, no consistent relationship was found between the various childhood physical activity factors and the cardiovascular risk factors of weight and blood pressure. Individual (nonfactored) physical activity measures also failed to correlate with children's physical activity. The results indicate that physical activity is not related to obesity and blood pressure in children. However, other interpretations (i.e., that the activity protocol was insufficiently accurate to detect subtle differences, or that children are not participating in enough physical activity to affect their cardiovascular health) are also possible.

The effects of having diabetes or obesity on simulated job decisions was evaluated in a two (qualifications, high v. marginal) by three (diabetes, mildly obese, or normal) design. Subjects were 295 adults, averaging 5.02 years of full-time employment in white-collar settings, recruited in advanced level graduate or undergraduate business classes. Each subject examined a job description and a resume of the 'applicant' and viewed a 5-minute videotape. The applicant's face was never seen and an off-camera voice, constant across all conditions, was dubbed in for the applicant's responses to the interviewer's questions. Subjects were then asked to rate the applicant's qualification level and demeanor during the interview and to recommend whether or not to hire the individual. Subjects were also asked to make ratings about the applicant's work habits, work reliability and absenteeism, and interpersonal skills (e.g. emotional problems, likeability). Results indicated that level of quantification affected decisions to hire the applicant in the predicted direction. However, the obese applicant was rated as less qualified for the job, and both the diabetic and obese applicant were less likely to be hired, although they were rated similarly on personal appearance, attitude during the interview, and communication skills. Additionally, both the obese and the diabetic applicant were viewed as having poorer work habits. The diabetic was rated as much more likely to have medically-related job absences, whereas the obese applicant was rated as more likely to have other absences (e.g. abusing company privileges by feigning illness) and to have emotional and interpersonal problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Carbon monoxide (CO) in expired breath is a common strategy for verifying smoking abstinence. The purpose of this investigation was to determine the comparability of two carbon monoxide (CO) analyzers: the commonly used Ecolyzer Series 2000 analyzer versus the new, highly portable, and less expensive Ecolyzer Model 210. Fifty-eight CO readings were obtained from 29 subjects (17 smokers, 12 nonsmokers) and analyzed on both systems simultaneously. Results indicated that the analyzers yielded highly comparable values for both smokers and nonsmokers. Moreover, the correlation between the two units' readings was very high (r = .92, p less than .001). There was, however, a significant analyzer by sex interaction with the Series 2000 analyzer yielding higher values for males. Overall, it was concluded that the Series 210 analyzer is a highly accurate and cost-effective instrument.

Examined demographic, environmental, and parent-child interactional correlates of physical activity in a group of 222 preschoolers. Activity levels were assessed with a system that quantified directly observed physical activity in the natural environment. Using regression-modeling procedures, results revealed a significant relationship between (a) child's relative weight, parental weight status, and percentage of time spent outdoors (environment) and (b) children's activity levels. Parental obesity was associated with lower levels of physical activity in children, childhood relative weight was associated with slightly higher levels of physical activity, and more outdoor activity was associated with higher activity levels. Parental participation in children's activities also significantly interacted with levels of parental obesity in predicting activity levels. Those children with a 50% risk for obesity (as defined by both, one, or neither parent being overweight) had small changes in activity across levels of parent-child interaction, whereas those at higher risk for obesity responded with increased activity as parent-child interactions increased. Results are discussed, and the implications of these findings for future intervention efforts are examined.

This investigation sought to determine the test-retest reliability and convergent validity of three commonly used physical activity measures. The Stanford Physical Activity Recall, the Caltrac Activity Monitor, and a daily physical activity log were administered to 45 subjects over a 3-week period. The results indicated high levels of test-retest reliability for the Stanford and the daily log; low test-retest reliability was obtained for the Caltrac. Convergent validity was also high between the Stanford and daily log but was low for both of these measures with the Caltrac. These results suggest that the Stanford Physical Activity Recall may be the self-report measure of choice for large studies due to its high reliability and convergent validity with a more time-consuming daily log, as well as its cost- and time-efficiency. Based on the results, it is recommended that the Caltrac activity sensors not be used for field studies of physical activity until the logistical problems of their use in clinical trials are solved.

Although the accuracy of dietary intake information for children has previously been studied, methodological issues make the results of those studies difficult to interpret. In order to address one of the major methodological issues, unobtrusive observations were performed on the lunch meal of 34 children. These children ranged in age from 4.0 to 9.5 years (mean = 5.8 years, standard deviation = 1.6 years). Each child was accompanied by both parents. Dietary recalls were obtained the following day from (a) the mother alone, (b) the father alone, and (c) the mother, father, and child reporting as a group (consensus recall). Recalls were analyzed with nutrition software that yields information on energy, protein, carbohydrate, sugar, total fat, cholesterol, sodium, iron, and calcium. Strong correlations were seen between each recall and the observation (mean r = .86). However, the group accuracy in correctly reporting different types of foods varied from the fathers' under-reporting of breads (-27%) to fathers' over-reporting of fruit (+50%). When regression analyses were used, only the consensus recall resulted in a regression line not significantly different from 1.0 for the majority of the nutrients analyzed. Thus, it appears that the consensus recall produced a better estimate of the observed intake from one meal than did recalls obtained from mother or father.

The present study evaluated the comparability of two microcomputer systems and two mainframe nutrient database systems. Sixty 24-hour recalls were analyzed on each system. Analysis of the nutrient values obtained from each system revealed several significant differences between Short Report and the other three systems. There were no significant differences between DINE, NCC, and UTNDB. Attempts to reveal the source of this error were not successful.