Search

Objective:To quantify the change in availability of hyper-palatable foods (HPF) in the US foods system over 30 years (1988–2018).Design:Three datasets considered representative of the US food system were used in analyses to represent years 1988, 2001 and 2018. A standardised definition from Fazzino et al. (2019) that specifies combinations of nutrients was used to identify HPF.Setting:Analysis of food-item level data was conducted. Differences in the prevalence of HPF were characterised by Cochran’s Q and McNemar’s tests. Generalised linear mixed models with a fixed effect for time and random intercept for food item estimated change in the likelihood that a food was classified as hyper-palatable over time.Participants:No participant data were used.Results:The prevalence of HPF increased 20 % from 1988 to 2018 (from 49 % to 69 %; P < 0·0001). The most prominent difference was in the availability of HPF high in fat and Na, which evidenced a 17 % higher prevalence in 2018 compared with 1988 (P < 0·0001). Compared with 1988, the same food items were >2 times more likely to be hyper-palatable in 2001, and the same food items were >4 times more likely to be classified as hyper-palatable in 2018 compared with 1988 (P values < 0·0001).Conclusions:The availability of HPF in the US food system increased substantially over 30 years. Existing food products in the food system may have been reformulated over time to enhance their palatability.

OBJECTIVE: Choice impulsivity may influence eating behavior. The study tested whether choice impulsivity, termed delay discounting, may be related to food generally, or may be specific to hyper-palatable foods (HPF). The study also determined whether a discounting task with choices between money and food may have utility in predicting obesity-related outcomes. METHOD: Participants (N = 284) completed a task that assessed choices between smaller reward available immediately and larger reward available later. Single commodity conditions presented choices between amounts of HPF, non-HPF, or money (e.g., HPF now vs. HPF later). Cross-commodity conditions presented choices between money and food commodities (e.g., money now vs. HPF later; money now vs. non-HPF later). RESULTS: There were no significant differences in discounting of HPF and non-HPF in single commodity conditions (Mean ln[k] difference = .40, p = .058). In the cross-commodity conditions holding money constant as the immediate reward, individuals discounted HPF significantly less than non-HPF (Mean ln[k] difference = .92; p = .0001). In regression analyses, individuals with excess HPF intake, greater HPF craving, and higher BMIs were more likely to choose HPF immediately, when money was the delayed reward (p values = .003 to .008). CONCLUSIONS: Choice impulsivity may be specific to foods that are hyper-palatable. Results suggest that individuals with excess HPF intake, higher HPF craving, and higher BMIs may exhibit a general tendency toward impulsive decision making that may be exacerbated in an obesogenic environment that provides wide access to HPF.

Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.Clinical Trials Registration Number: NCT04038190

We used a data-driven approach to determine the influence of energy density, hyper-palatability, protein content, and eating rate on ad libitum non-beverage energy intake during 2733 meals consumed by 35 inpatient adults who participated in two 28-day feeding studies. All four meal characteristics significantly contributed to energy intake, but their relative importance varied by the prevailing dietary pattern according to macronutrient composition and degree of processing.

Previous research has identified reward sensitivity as an important factor that may contribute to the engagement in eating behavior (e.g., binge eating, emotional eating, etc.) and increase obesity risk. In the current study, we conducted a systematic review of the literature to determine the relationships between reward sensitivity, eating behavior, and obesity-related outcomes. The study focused on two commonly used measures of reward sensitivity in the literature: the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) and the Behavioral Inhibition Scale/Behavioral Activation Scale (BIS/BAS Scale).We conducted a systematic search to identify studies that analyzed reward sensitivity as a predictor of eating behavior or obesity-related outcomes, and measured reward sensitivity using the SPSRQ or BIS/BAS Scale. The search yielded N=19 total publications included in the review.Findings indicated that reward sensitivity, primarily measured by summary scores on the SPSRQ or BIS/BAS Scale, were positively associated with a variety of eating behaviors and obesity-related outcomes with small to moderate effect sizes. Findings were most consistent across studies that examined the association between reward sensitivity and eating behavior outcomes (e.g., binge eating, emotional eating) (r values= .08 to .41; p values.001 to p.05) and food consumption outcomes (e.g., palatable food intake) (r values = .21 to .40; p.001 to p values.05). Findings were less consistent for food craving and BMI outcomes, and revealed these relationships may depend on individual-level factors and/or environment-related factors, (e.g., food cues). A quality evaluation using the Critical Appraisal Tool for Cross-Sectional Studies (AXIS tool) indicated that most studies were rated as moderate to strong quality (84%).Findings indicate that elevated reward sensitivity may be a risk factor for engagement in eating behaviors that may increase obesity risk.

We conducted an online survey to examine the preference, expected burden, and willingness of people to use four different methods of assessing food and alcohol intake such as food/drink record, 24-h recall, Remote Food Photography Method© (RFPM, via SmartIntake® app), and a novel app (PortionSize®) that allows the in-app portion size estimation of foods/drinks by the user. For food (N = 1959) and alcohol (N = 466) intake assessment, 67.3% and 63.3%, respectively, preferred the RFPM/SmartIntake®, 51.9% and 53.4% preferred PortionSize®, 48.0% and 49.3% the food records, and 32.9% and 33.9% the 24-h recalls (difference in preference across all methods was p &lt, 0.001 for food and alcohol intake). Ratings of burden and preference of methods were virtually superimposable, and we found strong correlations between high preference and low expected burden for all methods (all ρ ≥ 0.82, all p &lt, 0.001). Willingness (mean (SD)) to use the RFPM/SmartIntake® (food: 6.6 (2.0), alcohol: 6.4 (2.4)) was greater than PortionSize® (food: 6.0 (2.2), alcohol: 6.0 (2.4), 0.001) and 24-h recalls (food: 6.1 (2.2), alcohol: 5.7 (2.7), p &lt, 0.001), but not different from food records (food: 6.6 (2.0), alcohol: 6.5 (2.3), all p ≥ 0.33). Our results can be used in conjunction with existing data on the reliability and validity of these methods in order to inform the selection of methods for the assessment of food and alcohol intake.

Objective Extensive research has focused on hyper-palatable foods (HPF); however, HPF are defined using descriptive terms (e.g., fast foods, sweets), which are not standardized and lack specificity. The study purpose was to develop a quantitative definition of HPF and apply the definition to the Food and Nutrient Database for Dietary Studies (FNDDS) to determine HPF prevalence in the US food system. Methods A numeric definition of HPF was developed by extracting common HPF descriptive definitions from the literature and using nutrition software to quantify ingredients of fat, simple sugars, carbohydrates, and sodium. The definition was applied to the FNDDS. Results HPF from the literature aligned with three clusters: (1) fat and sodium (> 25% kcal from fat, ≥ 0.30% sodium by weight), (2) fat and simple sugars (> 20% kcal from fat, > 20% kcal from sugar), and (3) carbohydrates and sodium (> 40% kcal from carbohydrates, ≥ 0.20% sodium by weight). In the FNDDS, 62% (4,795/7,757) of foods met HPF criteria. The HPF criteria identified a variety of foods, including some labeled reduced or low fat and vegetables cooked in creams, sauces, or fats. Conclusions A data-derived HPF definition revealed that a substantial percentage of foods in the US food system may be hyper-palatable, including foods not previously conceptualized as hyper-palatable.

Background The transition to college is a developmentally sensitive time in which freshmen are at high risk for engaging in heavy drinking and experiencing changes in weight and body composition. The study tested prospective associations among drinking patterns (weekly drinks, heavy drinking occasions/month) and alcohol calorie intake on weight and waist circumference change over the first year of college. Methods College freshmen (N = 103) were randomly selected from a pool of eligible students to participate at the beginning of the academic year. The sample was comprised of 52% males, 46% of individuals identifying as racial or ethnic minority, and 45% students with at-risk drinking as defined by the Alcohol Use Disorders Identification Test-Consumption questions. Students engaging in daily risky drinking (n = 2) were excluded. Participants attended 3 visits during the academic year during which they provided weight and waist circumference measurements and completed assessments about drinking, dietary intake, and physical activity. Results Weight gain (>2.3 kg) occurred in 28% of participants. In linear mixed models, drinking patterns and alcohol calorie intake were not associated with weight or waist circumference changes within individuals, when controlling for demographic and energy balance variables. Drinking patterns and alcohol calorie intake did not account for differences in anthropometric measurements between participants, when controlling for covariates. Conclusions Alcohol use did not explain the anthropometric changes observed in a sample well represented by freshmen engaging in risky drinking (and excluding those with daily risky drinking) during the academic year. Drinking may not contribute to short-term weight gain among freshmen.

Leading eating disorder (ED) theories were informed primarily by samples of White females. Therefore, ED theories lack consideration of sociocultural factors that may impact ED symptom development among Black women. The current study proposed the first culturally informed theory for disordered eating among Black women, positing that ethnic discrimination, strong black woman (SBW) ideology (cultural and societal expectations of strength), and culturally informed appearance satisfaction may significantly impact stress. Stress may be associated with coping-motivated eating behaviors, which may lead to maladaptive weight control behaviors.Black women (N = 208) completed surveys assessing socio-cultural factors, stress, commensal and binge eating, and maladaptive weight control behaviors. Path analysis was used to test the proposed theory.The final model had a good fit for the data. Findings overall supported the hypothesized model. Specifically, higher ethnic discrimination (β = 0.044, p = .003), greater endorsement of SBW ideology (β = 0.074, p = .001), and lower culturally informed appearance satisfaction (β = -0.032, p = .025) were associated with greater stress. Stress was positively associated with binge eating (β = 0.457, p = .046), and binge eating was significantly associated with excessive exercise (=0.152, p = .008) and purging (β = 0.273, p = .001). In contrast, commensal eating was not associated with stress or weight control behaviors (p values = .697 to .749).The current study found that stress, as influenced by sociocultural factors, may play a role in binge eating, and subsequently, weight control behaviors among Black women. This theory is a starting point for future research on the specialized conceptualization of eating and maladaptive weight control behaviors among Black women.

Objective:To characterize the prevalence of hyperpalatable foods (HPF) among baby foods in the U.S. and examine the prevalence of HPF exposure and consumption from both baby food and adult food sources among infants aged 9–15 months.Methods:A U.S. baby food database as well as baby foods from three 24-h dietary recalls of 147 infants were used to identify baby foods as HPF per previous publication. HPF exposure was defined as intake of any HPF during the 3-day measurement period. To determine the extent of HFP consumption, % kilocalorie (kcal) intake from HPF was characterized.Results:Only 12% of baby foods were HPF; however, nearly all participants (>90%) consumed HPF, primarily through exposure to adult foods. Younger infants (Conclusions:The prevalence of HPF among baby foods in the U.S. is low. However, almost all infants were exposed to HPF, and HPF comprised a substantial percentage of daily food kilocalorie in infants' diets. Findings highlight the transition to solid food consumption during complimentary feeding period is a critical time for early HPF exposure.

Young adulthood is a high-risk period for heavy drinking and binge eating, both of which can impact weight and lead to obesity. Examining motives for drinking alcohol and eating palatable foods may facilitate a more integrated understanding of these behaviors during the college years. The current study tested whether shared or distinct (i.e., behavior-specific) motivational mechanisms may explain the occurrence of reward-driven drinking and eating in young adults.A sample of college freshmen (N = 103) stratified by sex, race/ethnicity, and heavy drinking status were selected to participate. Participants completed questionnaires measuring alcohol use, eating behavior, and motives assessed by the Drinking Motives Questionnaire-Revised and Palatable Eating Motives Scale. Confirmatory factor analysis (CFA) tested whether drinking and eating motives were better represented as single latent motives, or two behavior-specific motives. Structural equation modeling (SEM) was used to test the association between motivational factors and behaviors.Behavior-specific CFA models demonstrated stronger model fit and higher factor loadings than single motive models. SEM models indicated that eating to cope with negative emotions, to enhance positive experiences, to obtain social reinforcement, and to conform with peers were significantly associated with binge eating (p values .001). Enhancement and social drinking motives were significantly associated with number of weekly drinks (p values .001).While motives for drinking alcohol and eating palatable foods may satisfy common goals, findings suggest motivational mechanisms may be behavior-specific. Enhancement and social motives may be important factors to target in prevention programs for both drinking and binge eating.

Background Foods that increase obesity risk are ubiquitous in the US food environment. Such foods may be the target of hedonic eating, which may facilitate weight gain and lead to obesity. The study tested whether meal composition during an ad libitum buffet meal was associated with 1-year weight and percent body fat changes among healthy younger adults without obesity. Hyper-palatable foods (HPF) were the study focus; comparisons were conducted with high energy dense (HED) and ultra-processed foods (UPF). Design Younger adults without obesity (N = 82; 43% male; mean age 26.8) completed an ad libitum buffet meal and provided body composition measurements at baseline and 1-year follow up. Multiple regression models tested associations between the proportion of the target food consumed (HPF, HED, or UPF) during the ad libitum meal and 1) weight change and 2) percent body fat change. The proportion of HPF was characterized by HPF group, specifically carbohydrate and sodium (CSOD) foods or fat and sodium (FSOD) foods. Results Participants who consumed a greater proportion of CSOD HPF in their ad libitum buffet meals had significantly greater weight change (b = 0.354, p = .003) and percent body fat change (b = 0.247, p = .036) at 1-year follow up. In contrast, no significant associations were found between the proportion of FSOD HPF, HED, or UPF consumed and anthropometric outcomes (p values = .099-.938). Conclusions Eating a greater proportion of hyper-palatable CSOD foods ad libitum appears to be a pattern of hedonic eating, which may increase an individual's risk for weight and body fat gain in early adulthood.

PURPOSE: Physical activity may be difficult for survivors with poorer functioning following primary treatment. The study examined whether late symptoms of breast cancer treatment impact PA adoption (0–6 months) and maintenance (6–18 months) during a weight management intervention, and whether late symptoms influence PA when accounting for overall functioning. METHODS: Secondary analyses were conducted using a sample of survivors participating in a weight management intervention and who provided valid weight and accelerometer data at baseline and 6 months (N= 176). The Breast Cancer Prevention Trial Symptom Checklist (BCPT) assessed late treatment-related symptoms. SF-12 Physical Component Scale (PCS) and Mental Component Scale (MCS) scores assessed functioning. RESULTS: Change in bouted moderate to vigorous physical activity (MVPA) min/week from baseline to 6 months was not associated with BCPT scales (all p values >.05). When adding SF-12 scores to the model, change in bouted MVPA min/week was significantly associated with the PCS (p=.045). Change in MVPA min/week from 6 to 18 months was significantly associated with cognitive symptoms (p = .004), but not musculoskeletal or vasomotor symptoms (p values >.05). When adding 6-month SF-12 scores to the model, MVPA min/week was significantly associated with PCS (p= .001) and MCS (p= .028); however BCPT cognitive problems score became non-significant (p>.05) CONCLUSIONS: Poorer physical functioning was associated with lower PA adoption, and poorer mental and physical functioning was associated with lower maintenance of PA, while late symptoms generally were not. Interventionists should consider level of functioning when identifying individual PA goals during weight management interventions.

Background The college setting is considered an obesogenic environment due to high availability of palatable foods. However, only a minority of freshmen gain weight. Individual-level risk factors, such as impulsivity, may hold utility in predicting weight and adiposity changes. Individuals with an impulsive decision-making style may favor immediately rewarding foods at the expense of long-term health. Individuals who seek rewarding foods during strong emotions may also be at risk. The study tested decisional (delay-discounting; DD) and emotion-driven impulsivity (urgency) as risk factors for 1) weight and 2) body roundness change during freshman year. Methods Freshmen (N = 103) completed questionnaires assessing DD, positive urgency (PU), and negative urgency (NU). Weight and body roundness index (BRI) were collected at the beginning and end of the academic year. Four repeated measures regression models examined impulsivity factors predicting change in 1) weight and 2) BRI. Models included baseline weight and height or BRI, respectively. Covariates included average daily caloric intake, energy expenditure from walking, and sex. Results In models examining weight, neither DD nor NU were significantly associated with weight at follow-up (b = 0.008, p = .977; b = 0.280, p = .075) when holding covariates constant. In contrast, PU was significantly associated with weight at follow-up (b = 0.303, p = .033). In models examining BRI, DD (b = −0.039, p = .511) and PU (b = 0.049, p = .072) were not associated with BRI at follow-up. In contrast, NU was significantly associated with BRI at follow-up (b = 0.068, p = .017). Conclusions Emotion-driven impulsivity may be a risk factor for weight gain or change in body roundness during freshman year.

OBJECTIVE We set out to examine physicians' perceptions of the provision of ancillary services for opioid dependent patients receiving buprenorphine. METHODS An e-mail invitation describing the study was sent out by the American Society of Addiction Medicine to its membership (approximately 3700 physicians) and other entities (for a total of approximately 7000 e-mail addresses). E-mail recipients were invited to participate in a research study funded by the National Institutes on Drug Abuse involving completion of an online survey; 346 physicians completed the survey. RESULTS The majority of the 346 respondents were internal or family medicine (37%), or addiction medicine providers (30%), who were practicing in urban (57%) or suburban settings (27%). Most respondents reported either offering (66%) or referring patients for ancillary counseling (31%). Interventions that were most frequently offered or referrals provided were individual counseling (51%) and self-help groups (63%), respectively. Counseling availability differed significantly by provider specialization for any, individual, group, family or couples, and self-help groups. CONCLUSIONS Generally, respondents reported compliance with ancillary counseling requirements for buprenorphine treatment of opioid use disorder. In addition to examining the efficacy of a variety of ancillary counseling services for patients receiving opioid agonist treatment, further research should examine physicians' attitudes toward the role of such counseling in buprenorphine treatment. Although the study sample was relatively large, the generalizability of the findings is unclear, suggesting that further investigation of the availability of ancillary counseling in buprenorphine treatment among a larger nationally representative sample of providers may be warranted.

OBJECTIVES: Examine the impact of a multiple-goal (MG) vs single-goal (SG) lifestyle interventions on gestational diet quality and hyper-palatable food consumption. METHODS: Pregnant women were randomized in two pilot trials to MG (n = 21) or SG (n = 16) vs usual care (UC; combined trials, n = 18). The 18-week MG intervention included lifestyle modifications, and the 12-week SG intervention focused only on increasing fiber (≥30 g/day). Interventions included weekly instruction by a registered dietitian, and primary aims were appropriate weight gain. Diet recalls were performed at baseline and study end. Diet quality was scored with three versions of the alternative healthy eating index, including adaptations for pregnancy (AHEI 2010, AHEI-P, and AHEI-P 2010). Foods were classified as hyper-palatable based on fat, carbohydrate, sugar, and sodium content using previously defined criteria, and reported as percentage of total calories (%HPF). One-way ANOVA, paired t-tests, and Pearson's correlations were performed. RESULTS: At baseline, no between group differences for diet quality were found. By the end of the study, all diet quality scores increased for SG (P 0.05). At baseline, %HPF was different between groups (MG > UC > SG, 82%, 57%, and 26%, respectively; P 0.05), leaving MG and SG similar in %HPF (80% & 74%, respectively) and higher than UC (65%, P = 0.024). The %HPF was negatively correlated with all diet quality scores at baseline (r = −0.37 to −0.42; P 0.05). CONCLUSIONS: Interventions aimed to prevent excessive gestational weight gain showed improvements in diet quality. Hyper-palatable food consumption was negatively related to diet quality, yet neither intervention decreased %HPF. Focusing on increasing dietary fiber may allow for a targeted message with broad implications for diet quality, but more research is needed. FUNDING SOURCES: NIH Clinical and Translational Science Award and the Kansas City Area Life Science Institute.

Background Brief reinforcement-based psychosocial interventions such as behavioral activation (BA) and behavioral economics (BE) address imbalances in the reinforcement system that are strongly implicated in substance use. The present study reviewed a growing body of intervention studies that tested the efficacy of BA or BE in addressing substance use outcomes. The study also reviewed a smaller body of evidence exploring mechanisms of action and moderators of treatment efficacy for substance use outcomes. Method A comprehensive literature search of four databases was conducted to identify studies that tested either BA or BE interventions targeting outcomes and/or mechanisms of action specific to substance use. The search yielded 12 studies that met these criteria. Ten studies reported main outcomes of BA/BE interventions targeting substance use outcomes (N = 7 BA; N = 3 BE). Two additional studies addressed mechanisms of change by conducting secondary analyses of data from one of the other ten studies. Eight of the twelve studies tested mechanisms of change and/or moderators related to substance use. Results Among all ten outcome studies, 100% provided evidence suggesting efficacy of BA/BE in targeting substance use and/or use-related problems. In 90% (9/10) of studies, the BA/BE intervention condition evidenced significantly higher abstinence rates compared to controls and/or significant decreases in substance use from baseline. Most studies that assessed substance use-related problems (83%; 5/6) reported significant decreases in use-related problems. The majority of studies (80%; 8/10) reported medium to large effect sizes. The pattern of findings was similar for BA and BE interventions. Eight studies assessed change in mechanism of action and 38% (3/8) identified mechanisms of action, however, only two conducted a formal test of whether this variable mediated the relationship between condition and outcome. Two studies tested and identified significant moderators of treatment efficacy. Conclusions Preliminary evidence supports the efficacy of reinforcement-based interventions in targeting substance use outcomes. The mechanisms driving BA/BE efficacy and factors that may moderate treatment effects are not sufficiently clear from the studies available and require further examination, although existing data does suggest promise and provides clues for next steps.

Introduction The transition from high school to college is a developmentally sensitive period that is high-risk for the escalation of alcohol use. Although risky drinking is a common problem among freshmen, engagement in treatment services is very low. College alcohol interventions target drinking directly at a time when students may be uninterested in changing their drinking. Approaches that indirectly target drinking may be particularly effective. Behavioral activation (BA) is an intervention that indirectly addresses mental health conditions by guiding individuals to engage in reinforcing activities that align with their values (Lejuez et al., 2001). A pilot study of a BA intervention administered in a semester-long freshman orientation course reported a significant decrease in drinking-related problems compared to students in standard orientation course (Reynolds et al., 2011). Methods The cluster-randomized trial will test the efficacy of BA administered in a semester-long (16 week) freshman orientation course, compared to a standard orientation course in 540 freshmen spread over 36 course sections (18 sections each). A 5-month post-treatment assessment will measure durability of effects. Discussion The study will test a promising BA intervention that addresses factors limiting participation in other programs by targeting alcohol use indirectly and by integrating an intervention into college curriculum. This study represents a first step toward developing an intervention course that could be widely disseminated to address the persistent college drinking problem and its consequences. Clinical trials registration number NCT04038190.

Background Heavy drinking is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to bias. Objective The purpose of our study was to conduct feasibility testing of the Remote Food Photography Method and the SmartIntake app to assess alcohol use in young adults. Aims consisted of (1) quantifying the ability of SmartIntake to capture drinking behavior, (2) assessing app usability with the Computer System Usability Questionnaire (CSUQ), (3) conducting a qualitative interview, and (4) comparing preference, usage, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake and online diet recalls that participants completed for a parent study. Methods College students (N=15) who endorsed a pattern of heavy drinking were recruited from a parent study. Participants used SmartIntake to send photographs of all alcohol and food intake over a 3-day period and then completed a follow-up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total drinking occasions were determined by adding the number of drinking occasions captured by SmartIntake plus the number of drinking occasions participants reported that they missed capturing. Usage was defined by the number of days participants provided food/beverage photos through the app, or the number of diet recalls completed. Results SmartIntake captured 87% (13/15) of total reported drinking occasions. Participants rated the app as highly usable in the CSUQ (mean 2.28, SD 1.23). Most participants (14/15, 93%) preferred using SmartIntake versus recalls, and usage was significantly higher with SmartIntake than recalls (42/45, 93% vs 35/45, 78%; P=.04). Triple the number of participants submitted alcohol reports with SmartIntake compared to the recalls (SmartIntake 9/15, 60% vs recalls 3/15, 20%; P=.06), and 60% (9/15) of participants reported drinking during the study. Conclusions SmartIntake was acceptable to college students who drank heavily and captured most drinking occasions. Participants had higher usage of SmartIntake compared to recalls, suggesting SmartIntake may be well suited to measuring alcohol consumption in young adults. However, 40% (6/15) did not drink during the brief testing period and, although findings are promising, a longer trial is needed.

BACKGROUND Heavy alcohol use is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to biases. OBJECTIVE The purpose of the pilot study was to conduct feasibility testing of SmartIntake®, a photo-based smartphone app, to assess alcohol use among young adults. Aims consisted of 1) quantifying the ability of SmartIntake® to capture drinking behavior; 2) assessing app usability with the Computer System Usability Questionnaire (CSUQ); 3) conducting a qualitative interview; and 4) comparing preference, compliance, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake® and online diet recalls that participants completed for a parent study. METHODS College students (N=15) who endorsed a pattern of heavy drinking were recruited from a larger study examining the impact of drinking on weight. Participants used SmartIntake® to send photographs of all alcohol and food intake over a three-day period, and then completed a follow up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total number of drinking occasions was determined by adding the number of drinking occasions captured by SmartIntake® plus the number of drinking occasions participants reported that they missed capturing. Compliance was defined by the number of days participants provided food/beverage photo data through the app, or the number of diet recalls completed. RESULTS The SmartIntake® app captured 13 of 15 (87%) drinking occasions. Participants rated the app as highly usable in the CSUQ (M= 2.28). Most participants (93%) preferred using SmartIntake® vs. recalls and compliance was significantly higher with SmartIntake® than recalls (93% vs 78%; P= .04). Alcohol grams and calories per drinking occasion were not significantly different between the two methods (P values range .25-.99); however triple the number of participants submitted alcohol reports with SmartIntake® compared to the diet recalls (SmartIntake® 9/15 vs recalls 3/15; P=.06). CONCLUSIONS SmartIntake® was well accepted by college students who drink heavily and captured most drinking occasions. Participants had higher compliance with SmartIntake® compared to diet recalls and triple the number of participants reported alcohol use with SmartIntake®, suggesting this method may be well suited to assessing alcohol use in young adults.

Objective Web-based brief alcohol intervention (WBI) programs have efficacy in a wide range of college students and have been widely disseminated to universities to address heavy alcohol use. In the majority of efficacy studies, web-based research assessments were conducted before the intervention. Web-based research assessments may elicit reactivity, which could inflate estimates of WBI efficacy. The current study tested whether web-based research assessments conducted in combination with a WBI had additive effects on alcohol use outcomes, compared to a WBI only. Methods Undergraduate students (n = 856) from universities in the United States and Canada participated in this online study. Eligible individuals were randomized to complete 1) research assessments + WBI or 2) WBI-only. Alcohol consumption, alcohol-related problems, and protective behaviors were assessed at one-month follow up. Results Multiple regression using 20 multiply imputed datasets indicated that there were no significant differences at follow up in alcohol use, alcohol-related problems, or protective behaviors used when controlling for variables with theoretical and statistical relevance. A repeated measures analysis of covariance revealed a significant decrease in peak estimated blood alcohol concentration in both groups, but no differential effects by randomized group. There were no significant moderating effects from gender, hazardous alcohol use, or motivation to change drinking. Conclusions Web-based research assessments combined with a web-based alcohol intervention did not inflate estimates of intervention efficacy when measured within-subjects. Our findings suggest universities may be observing intervention effects similar to those cited in efficacy studies, although effectiveness trials are needed.

Objective Obesity and weight gain after breast cancer treatment are common among survivors, yet the relationship between weight and body image has received little attention. The purpose of the current study was to examine the relationship between current body mass index, weight gain since diagnosis, and largest weight fluctuation in adulthood with six dimensions of body image among overweight/obese breast cancer survivors. Methods The current study used data obtained from a weight control trial with 210 rural overweight/obese breast cancer survivors. Using data collected at baseline, multiple regression models were constructed to examine the relative association of the three weight variables with breast cancer-specific dimensions of body image while controlling for demographic characteristics and cancer treatment-related variables. Results Largest weight fluctuation in adulthood significantly predicted overall body image (p = 0.01) and was associated with the three socially oriented dimensions of body image: social activity restriction, embarrassment about appearance, and sexuality (all ps = 0.01). Weight gain since diagnosis approached statistical significance in predicting overall body image (p = 0.05) and was associated with embarrassment about appearance (p = 0.03). Current body mass index was not significantly associated with overall body image when controlling for the other weight variables (p = 0.07) and was negatively associated with social activity restriction (p = 0.01) and sexuality (p = 0.01). Conclusions Obese breast cancer survivors with a history of a large weight fluctuation in adulthood may be prone to poorer breast cancer-specific body image several years after treatment. Copyright © 2015 John Wiley & Sons, Ltd.

Alcohol brief intervention (BI) in primary care (PC) is effective, but remains underutilized despite multiple efforts to increase provider-initiated BI. An alternative approach to promote BI is to prompt patients to initiate alcohol-related discussions. Little is known about the role of patients in BI delivery.To determine the characteristics of PC patients who reported initiating BI with their providers, and to evaluate the association between the initiator (patient vs provider) and drinking after a BI.In the context of clinical trial, patients (n = 267) who received BI during a PC visit reported on the manner in which the BI was initiated, readiness to change, demographics, and recent history of alcohol consumption. Drinking was assessed again at 6-months after the BI.Fifty percent of patients receiving a BI reported initiating the discussion of drinking themselves. Compared with those who reported a provider-initiated discussion, self-initiators were significantly younger (43.7 years vs 47.1 years; P = 0.03), more likely to meet Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for current major depression (24% vs 14%; P = 0.04), and more likely to report a history of alcohol withdrawal symptoms (68% vs 52%; P 0.01). Baseline readiness to change, baseline consumption rates, and current DSM-IV alcohol dependence were not different between groups. In the 2 to 3 weeks after BI, self-initiators reported greater decreases in drinks per week (5.7 vs 2.4; P = 0.02), and drinking days per week (1.0 vs 0.3; P = 0.002). At 6-month follow-up, self-initiators showed significantly greater reductions in weekly drinking compared to those whose provider initiated the BI (P = 0.002).Patient- and provider-initiated BI occurred with equal frequency, and patient-initiated BIs were associated with greater reductions in alcohol use. Future efforts to increase the BI rate in PC should include a focus on prompting patients to initiate alcohol-related discussions.

Recruiting young adults for health research is challenging. Social media provides wide access to potential research participants. We evaluated the feasibility of recruiting students via free message postings on Facebook and Twitter to participate in a web-based brief intervention study. The sample comprised students attending U.S. and Canadian universities.During three semesters, institutional review board-approved recruitment messages were posted in 281 Facebook groups, 7 Facebook pages, and 27 message "tweets" on Twitter.A total of 708 eligible participants were recruited from Facebook. The mean enrollment rate per Facebook group was 0.21%; the rate was higher for host university groups (1.56%) compared with groups at other universities (0.10%). We recruited seven participants from Twitter. The sample was predominantly female (70%) with a mean age of 20.0 years. There were no significant differences between host university participants recruited through social media and traditional methods. The web-based intervention completion rate was 65%, and participants from the host university were more likely to complete the intervention than were groups at other universities (p = .01).Social media provides access to a large number of potential participants, and social media recruitment may be useful to researchers who can harness this broad reach. Facebook recruitment was feasible and free and resulted in a large number of enrolled participants. Social media recruitment for researchers at their own universities may be particularly fruitful. Despite wide access to students with Twitter, recruitment was slow. Social media recruitment allowed us to extend web-based intervention access to students in the United States and Canada.

Objective This study examined the effects of a group phone-based weight management intervention on change in physical activity as measured via accelerometer and self-report in rural breast cancer survivors. The study also evaluated the role of physical activity on clinically meaningful cut points for weight loss (baseline to 6 months) and weight loss maintenance (6 to 18 months). Methods Participants were breast cancer survivors in a weight management intervention who provided valid weight and accelerometer data (N = 142). Participants were categorized into four groups based on weight loss ≥10% and weight regain ≥5% at 18 months. Results Accelerometer-measured moderate-to-vigorous physical activity (MVPA) significantly increased from baseline to 6 months (+46.9 minutes). MVPA declined during maintenance but remained significantly greater than baseline. Self-reported MVPA followed a similar pattern as accelerometer MVPA, but estimates were significantly higher. Participants in the high loss, low regain group had significantly higher MVPA at all points. Conclusions A distance-based weight management intervention for survivors improved physical activity outcomes over 18 months. Self-reported physical activity was substantially higher than accelerometer measured. Findings highlight the importance of device-based measurement for characterizing the magnitude of physical activity change as well as the role of physical activity in weight management outcomes.

Introduction Heavy episodic alcohol use during young adulthood may contribute to excess weight gain and transition from healthy weight to overweight/obesity. This study is the first to evaluate the association between heavy episodic drinking during early adulthood and transition to overweight/obese status 5 years later using data from the U.S. National Longitudinal Study of Adolescent to Adult Health. Methods The study used data from Waves III and IV, when participants were aged 18–26 and 24–32 years, respectively. The final sample consisted of 7,941 participants with measured height/weight who reported ever drinking alcohol. Multinomial logistic regression models tested the association between heavy episodic drinking and risk of transitioning to an unhealthy weight class. Results Heavy episodic drinking was associated with 41% higher risk of transitioning from normal weight to overweight (relative risk ratio, 1.41; 95% CI=1.13, 1.74; p =0.002) and 36% higher risk of transitioning from overweight to obese by Wave IV (relative risk ratio, 1.36; 95% CI=1.09, 1.71; p =0.008), compared with individuals not drinking heavily, while accounting for covariates. Heavy episodic drinking was associated with 35% higher risk of maintaining obesity (relative risk ratio, 1.35; CI=1.06, 1.72; p =0.016) and gaining excess weight (OR=1.20, 95% CI=1.03, 1.39, p =0.02). Conclusions Regular heavy episodic drinking in young adulthood is associated with higher risk of gaining excess weight and transitioning to overweight/obesity. Obesity prevention efforts should address heavy drinking as it relates to caloric content and risk of transitioning to an unhealthy weight class.

The DSM specifies categorical criteria for psychiatric disorders. In contrast, a dimensional approach considers variability in symptom severity and can significantly improve statistical power. The current study tested whether a categorical, DSM-defined diagnosis of Alcohol Dependence (AD) was a better fit than a dimensional dependence measure for predicting change in alcohol consumption among heavy drinkers following a brief alcohol intervention (BI). DSM-IV and DSM-5 alcohol use disorder (AUD) measures were also evaluated.Participants (N=246) underwent a diagnostic interview after receiving a BI, then reported daily alcohol consumption using an Interactive Voice Response system. Dimensional AD was calculated by summing the dependence criteria (mean=4.0; SD=1.8). The dimensional AUD measure was a summation of positive Alcohol Abuse plus AD criteria (mean=5.8; SD=2.5). A multi-model inference technique was used to determine whether the DSM-IV categorical diagnosis or dimensional approach would provide a more accurate prediction of first week consumption and change in weekly alcohol consumption following a BI.The Akaike information criterion (AIC) for the dimensional AD model (AIC=7625.09) was 3.42 points lower than the categorical model (AIC=7628.51) and weight of evidence calculations indicated there was 85% likelihood that the dimensional model was the better approximating model. Dimensional AUD models fit similarly to the dimensional AD model. All AUD models significantly predicted change in alcohol consumption (p's=.05).A dimensional AUD diagnosis was superior for detecting treatment effects that were not apparent with categorical and dimensional AD models.

Young adulthood is a sensitive developmental period that is high-risk for weight gain. Ample research has focused on weight gain among college students; however meta-analyses report2 kg pooled estimates of weight gain, which is in the range of normal weight fluctuation, and there is disagreement in the literature regarding common predictors of weight gain. These limitations pose a major barrier to targeted obesity prevention efforts. The present study reviewed the literature assessing college weight gain with a focus on three methodological factors that could contribute to variability in the literature: 1) use of an evidence-supported definition of weight gain (2 kg or ≥3%); 2) weight measurement protocols; and 3) including weight/BMI in analyses of predictors of weight change.Three databases were systematically searched. Studies were included in the review if the primary goal was to determine magnitude of weight change and/or test predictors of weight change during the academic year, and they reported weight at 2+ time points.A total of 81 studies were included in the review. Most studies (90%; 73/81) did not use an evidence-supported definition of weight gain. Studies that used an evidence-supported definition reported estimates of gain among students who gained weight to be beyond the range of normal weight fluctuation (4.0-7.5 kg), and occurred in a subset (32%) of participants. Studies that did not use an evidence-supported definition reported weight gain to be 2.0-4.5 kg, and occurred in the majority50% of students. Most studies that measured height and weight (71%; 42/59) did not use a fasting protocol and the majority (63%; 37/59) did not conduct measurements at the same time of day. A higher percentage of studies that used a standardized measurement protocol reported weight change2 kg (44% vs 20%). A lower percentage of studies that used a standardized measurement protocol had substantial variability in weight change estimates (50% vs 69%). The majority of studies that tested predictors of weight gain (74%; 42/57) included weight/BMI as a covariate in analyses.The body of literature examining weight change among college students suffers from limitations that may have contributed to overestimations in the percent of students who gain weight, and simultaneous underestimations of the magnitude of weight gain among those who gain weight. Weight gain may be limited to approximately 30% of students in a sample, and weight gain among this subset of students may be substantial (4 kg). Going forward, use of both an evidence-supported weight gain definition and fasting measurement protocol will likely enhance accuracy in characterizing weight gain among college students, as well as improve researchers' ability to detect important predictors of weight gain.

Background Craving is a central component to alcohol use disorders, although there are contradictory findings in the literature regarding the importance of craving in alcohol use. The study goal was to examine the bidirectional relationship between craving and alcohol consumption in heavy drinkers. Methods Participants received brief alcohol interventions from their primary care physicians and then were asked to make daily reports of craving and alcohol consumption to an interactive voice response (IVR) telephone system for 180 days. The study sample included 246 participants (166 men) with mean age of 46. Ninety-seven percent were Caucasian and 66% met criteria for alcohol dependence. Analysis used generalized estimating equations (GEE) to evaluate whether craving intensity predicted next day alcohol consumption and whether alcohol consumption predicted next day craving intensity. Significant interactions with gender led to stratified analyses. Results GEE analyses revealed a significant bidirectional relationship between craving and drinking, where craving intensity predicted next day total drinks consumed (p = 0.001), and total drinks predicted next day craving intensity (p = 0.02). Exploratory analysis found that gender significantly moderated the craving–drinking relationship (p = 0.002) with men increasing next day alcohol use more (b = 0.19) than women (b = 0.08). Conclusions Findings suggest a bidirectional relationship between craving and drinking may contribute to the development or maintenance of heavy drinking, particularly for men. Based on our findings, we recommend that during brief interventions, physicians address both drinking and craving and provide advice for coping with craving.

The current pilot study evaluated feasibility, acceptability, and initial efficacy of a therapeutic Interactive Voice Response (IVR) system (“The Recovery Line”) for patients receiving methadone maintenance who continue to use illicit drugs. Patients were randomized (N=36) to four weeks of Treatment-as-Usual (TAU) or Recovery Line plus TAU. Ratings of The Recovery Line were high and remained stable throughout the study. However, despite instructions and reminders, patients used substantially less than the recommended daily use (

Obesity and diet quality are two distinct lifestyle factors associated with morbidity and mortality among breast cancer survivors. The purposes of this study were to examine diet quality changes during a weight loss intervention among breast cancer survivors and to examine whether diet quality change was an important factor related to weight loss.Participants were overweight/obese breast cancer survivors (n = 180) participating in a weight loss intervention. Diet quality scores were calculated using the Healthy Eating Index (HEI)-2010. Paired sample t-tests were run to examine change in diet quality, and a latent difference model was constructed to examine whether change in diet quality was associated with weight change.Participants significantly improved diet quality (P = 0.001) and lost 13.2 ± 5.8% (mean ± SD) of their weight (P = 0.001). Six-month HEI score was significantly associated with weight loss, controlling for baseline BMI (P = 0.003). Improvement in diet quality was also significantly associated with weight loss (P = 0.01).Our findings indicate that a weight loss intervention can result in both clinically significant weight loss and improvement in diet quality, and that improved diet quality is predictive of weight loss. Both weight loss and diet quality are implicated in longevity and quality of life for breast cancer survivors.

Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24 months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N=1440) age 20 to 75 with a BMI 30-45 kg/m(2). In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24 months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care.

Obesity is prevalent in breast cancer survivors and is a significant risk factor for recurrence and mortality. Weight management interventions for survivors have been diverse in design (in-person vs. phone-based, group vs. individual) and yielded varying weight loss results. Given these issues, participants themselves may provide insight into treatment-based factors that contributed to their weight loss outcomes. Here, we report qualitative results from interviews with survivors in a group phone-based weight loss intervention, with the objective of identifying mechanisms that facilitated or hindered adherence and weight loss. We explored interest in paying for continued treatment as an indicator of dissemination potential. Individual interviews were conducted with 186 rural, obese breast cancer survivors upon completion of a 6-month weight loss intervention that produced clinically meaningful weight loss (>5 %) in 91 % of participants. A thematic analysis of the interview data was performed. Five themes were identified as impacting adherence and success: (1) accountability; (2) importance of the group, with varying levels of connectedness; (3) dietary convenience; (4) difficulty maintaining intervention components that required more effort; and (5) importance of internal motivation to attributions of physical activity success or failure. Most were interested in paying to continue the program if it were extended beyond the study. Key intervention components that participants attributed to their success included supportive group processes and convenience. Results highlight the group phone-based approach as a potential venue for disseminating an effective weight loss program for breast cancer survivors. NCT01441011

In primary care, collecting information about patient health behaviors between appointments can be advantageous. Physicians and researchers who embrace phone-based technology may find valuable ways to monitor patient-reported outcome measures of health (PROM). However, the level of phone technology sophistication should be tailored to the phone use of the population of interest. Despite the growing use of telephones as a means to gather PROM, little is known about phone use among primary care patients. As part of an ongoing study, the authors recruited primary care patients (N = 9126) for a health behavior screening study by calling them on the primary contact number listed in their medical record. The current study evaluated the frequency with which individuals were reached on landlines, basic cell phones, and smartphones, and examined participant characteristics. The majority of participants (63%) used landlines as their primary contact. Of the 37% using cell phones on the recruitment call, most (71%) were using smartphones. Landline users were significantly older than cell phone users (61.4 vs. 46.2 years; P = .001). Cell phone use did not differ significantly between participants with a college education and those without (37% vs. 38%; P = .82); however, smartphone use did differ (61% vs. 77%; P = .01). The majority of participants sampled used landlines as their primary telephone contact. Researchers designing phone-based PROM studies for primary care may have the broadest intervention reach using interactive voice response telephone technology, as patients could report health outcomes from any type of phone, including landlines. (Population Health Management 2016;19:212-215).

Obesity and weight gain after breast cancer treatment are common among survivors, yet the relationship between weight and body image has received little attention. The purpose of the current study was to examine the relationship between current body mass index, weight gain since diagnosis, and largest weight fluctuation in adulthood with six dimensions of body image among overweight/obese breast cancer survivors.The current study used data obtained from a weight control trial with 210 rural overweight/obese breast cancer survivors. Using data collected at baseline, multiple regression models were constructed to examine the relative association of the three weight variables with breast cancer-specific dimensions of body image while controlling for demographic characteristics and cancer treatment-related variables.Largest weight fluctuation in adulthood significantly predicted overall body image (p = 0.01) and was associated with the three socially oriented dimensions of body image: social activity restriction, embarrassment about appearance, and sexuality (all ps = 0.01). Weight gain since diagnosis approached statistical significance in predicting overall body image (p = 0.05) and was associated with embarrassment about appearance (p = 0.03). Current body mass index was not significantly associated with overall body image when controlling for the other weight variables (p = 0.07) and was negatively associated with social activity restriction (p = 0.01) and sexuality (p = 0.01).Obese breast cancer survivors with a history of a large weight fluctuation in adulthood may be prone to poorer breast cancer-specific body image several years after treatment. Copyright © 2015 John WileySons, Ltd.

Background For the DSM-5-defined alcohol use disorder (AUD) diagnosis, a tri-categorized scale that designates mild, moderate, and severe AUD was selected over a fully dimensional scale to represent AUD severity. The purpose of this study was to test whether the DSM-5-defined AUD severity measure was as proficient a predictor of alcohol use following a brief intervention, compared to a fully dimensional scale. Methods Heavy drinking primary care patients (N = 246) received a physician-delivered brief intervention (BI), and then reported daily alcohol consumption for six months using an Interactive Voice Response (IVR) system. The dimensional AUD measure we constructed was a summation of all AUD criteria met at baseline (mean = 6.5; SD = 2.5). A multi-model inference technique was used to determine whether the DSM-5 tri-categorized severity measure or a dimensional approach would provide a more precise prediction of change in weekly alcohol consumption following a BI. Results The Akaike information criterion (AIC) for the dimensional AUD model (AIC = 7623.88) was four points lower than the tri-categorized model (AIC = 7627.88) and weight of evidence calculations indicated there was 88% likelihood the dimensional model was the better approximating model. The dimensional model significantly predicted change in alcohol consumption (p = .04) whereas the DSM-5 tri-categorized model did not. Conclusion A dimensional AUD measure was superior, detecting treatment effects that were not apparent with tri-categorized severity model as defined by the DSM-5. We recommend using a dimensional measure for determining AUD severity.

OBJECTIVE Recently, there has been a gradual shift from inpatient-only electroconvulsive therapy (ECT) toward outpatient administration. Potential advantages include convenience and reduced cost. But providers do not have the same opportunity to monitor treatment response and adverse effects as they do with inpatients. This can obviate some of the potential advantages of outpatient ECT, such as tailoring treatment intervals to clinical response. Scheduling is typically algorithmic rather than empirically based. Daily monitoring through an automated telephone, interactive voice response (IVR), is a potential solution to this quandary. METHODS To test feasibility of clinical monitoring via IVR, we recruited 26 patients (69% female; mean age, 51 years) receiving outpatient ECT to make daily IVR reports of affective symptoms and subjective memory for 60 days. The IVR also administered a word recognition task daily to test objective memory. Every seventh day, a longer IVR weekly interview included questions about suicidal ideation. RESULTS Overall daily call compliance was high (mean, 80%). Most participants (96%) did not consider the calls to be time-consuming. Longitudinal regression analysis using generalized estimating equations revealed that participant objective memory functioning significantly improved during the study (P < 0.05). Of 123 weekly IVR interviews, 41 reports (33%) in 14 patients endorsed suicidal ideation during the previous week. CONCLUSIONS Interactive voice response monitoring of outpatient ECT can provide more detailed clinical information than standard outpatient ECT assessment. Interactive voice response data offer providers a comprehensive, longitudinal picture of patient treatment response and adverse effects as a basis for treatment scheduling and ongoing clinical management.

Background: Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective: To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods: Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results: Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions: Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration: Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9) [JMIR Cancer 2016;2(2):e15]

A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater availability compared to traditional treatment. Electronic searches were conducted from 1966 to November 19, 2009, using MEDLINE, Psychlit, and EMBASE. Four hundred sixty-eight nonduplicate records were identified. Two reviewers classified abstracts for study inclusion, resulting in 12 studies of moderate quality. Eleven studies were pilot or full-scale trials compared to a control condition. Interventions showed high acceptability despite substantial variation in type and amount of treatment. Compared to treatment-as-usual, computer-based interventions led to less substance use and higher motivation to change, better retention, and greater knowledge of presented information. Computer-based interventions for drug use disorders have the potential to dramatically expand and alter the landscape of treatment. Evaluation of Internet- and telephone-based delivery that allows for treatment-on-demand in patients' own environment is needed.