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Biomedical subjects

R C Brownson

Publications and source records attributed to R C Brownson.

At least 19 recordsLinked to original sources
PubMed2007

Perceived and observed neighborhood indicators of obesity among urban adults.

OBJECTIVE: The global obesity epidemic has been partially attributed to modern environments that encourage inactivity and overeating, yet few studies have examined specific features of the physical neighborhood environment that influence obesity. Using two different measurement methods, this study sought to identify and compare perceived and observed neighborhood indicators of obesity and a high-risk profile of being obese and inactive. DESIGN: Cross-sectional telephone surveys (perceived) and street-scale environmental audits (observed) were conducted concurrently in two diverse US cities to assess recreational facility access, land use, transportation infrastructure and aesthetics. SUBJECTS: A total of 1032 randomly selected urban residents (20% obese, 32% black, 65% female). ANALYSIS: Bivariate and multivariate logistic regression analyses were conducted to estimate the association (adjusted prevalence odds ratio (aOR)) between the primary outcome (obese vs normal weight) and perceived and observed environmental indicators, controlling for demographic variables. RESULTS: Being obese was significantly associated with perceived indicators of no nearby nonresidential destinations (aOR=2.2), absence of sidewalks (aOR=2.2), unpleasant community (aOR=3.1) and lack of interesting sites (aOR=4.8) and observed indicators of poor sidewalk quality (aOR=2.1), physical disorder (aOR=4.0) and presence of garbage (aOR=3.7). Perceived and observed indicators of land use and aesthetics were the most robust neighborhood correlates of obesity in multivariate analyses. CONCLUSIONS: The findings contribute substantially to the growing evidence base of community-level correlates of obesity and suggest salient environmental and policy intervention strategies that may reduce population-level obesity prevalence. Continued use of both measurement methods is recommended to clarify inconsistent associations across perceived and observed indicators within the same domain.

Adolescent↗
PubMed2006

A comparison of national estimates of obesity prevalence from the behavioral risk factor surveillance system and the National Health and Nutrition Examination Survey.

BACKGROUND: Obesity interventions are implemented at state or sub-state level in the United States (US), where only self-reported weight and height data for adults are available from the Behavioral Risk Factor Surveillance System (BRFSS). The prevalence estimates of overweight and obesity generated from self-reported weight and height from BRFSS are known to underestimate the true prevalence. However, whether this underestimation is consistent across different demographic groups has not been fully investigated. METHODS: In this study, we compared the prevalence estimates of obesity (body mass index (BMI) > or =30 kg/m(2)) and overweight (BMI > or =25 kg/m(2)) in different demographic groups in the US from the National Health and Nutrition Examination Survey (NHANES) and BRFSS during 1999-2000. We also compared the rank orders of the obesity and overweight prevalence across different demographic groups from the two data sources. RESULTS: Compared to NHANES, BRFSS underestimated the overall prevalence of obesity and overweight by 9.5 and 5.7 percentage points, respectively. The underestimation differed across different demographic groups: the underestimation of obesity and overweight prevalence was higher among women (13.1 and 12.2 percentage points, respectively) than among men (5.8 and -0.6 percentage points, respectively). The variation of underestimation was higher among men. A clear inverse association between educational attainment and obesity prevalence among non-Hispanic African American women was observed from BRFSS data. However, no such association was found from NHANES. While BRFSS can identify correctly the population with the highest obesity and overweight burden, it did not accurately rank the obesity and overweight prevalence across different demographic groups. CONCLUSION: Compared to NHANES, BRFSS disproportionately underestimates the prevalence of obesity and overweight across different gender, race, age, and education subgroups.

Adult↗
PubMed2005

Strength of clean indoor air laws and smoking related outcomes in the USA.

OBJECTIVES: Environmental tobacco smoke (ETS) is often encountered in the workplace. There have been efforts to apply and enforce state laws limiting workplace smoking. There has been little study of the relative effectiveness of state and/or local laws in affecting both rates of workplace ETS exposure and adult smoking rates. This study investigates these hypotheses, as well as the effect of these laws on youth smoking. DESIGN: This is a secondary data analysis using sources including the Current Population Survey (CPS), Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Survey (YRBS), and the National Household Survey of Drug Abuse (NHSDA) between the years of 1996 and 1999. Linear regression models were used to investigate the effect of a state's clean indoor air (CIA) law (using a measure of extensiveness) on the overall amount of people who reported working in a smoke-free environment, youth smoking rates and adult smoking rates. RESULTS: The extensiveness of a state's CIA law was found to be a reliable predictor of the percentage of indoor workers who report a smoke-free work environment and the rates of youth smoking. State CIA laws were not conclusively associated with adult smoking rates. CONCLUSIONS: The extensiveness of a state's CIA law is strongly associated with a higher percentage of indoor workers reporting a smoke-free work environment. This study did not reveal a similar association between local laws and smoke-free work environments. Youth smoking rates, shown to be related to state CIA laws, may be further affected with more stringent CIA policy.

Adolescent↗
PubMed2003

Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States.

STUDY OBJECTIVES: Few studies have analysed the rates and correlates of physical activity in economically and geographically diverse populations. Objectives were to examine: (1) urban-rural differences in physical activity by several demographic, geographical, environmental, and psychosocial variables, (2) patterns in environmental and policy factors across urban-rural setting and socioeconomic groups, (3) socioeconomic differences in physical activity across the same set of variables, and (4) possible correlations of these patterns with meeting of physical activity recommendations. DESIGN: A cross sectional study with an over sampling of lower income adults was conducted in 1999-2000. SETTING: United States. PARTICIPANTS: 1818 United States adults. MAIN RESULTS: Lower income residents were less likely than higher income residents to meet physical activity recommendations. Rural residents were least likely to meet recommendations; suburban residents were most likely to meet recommendations. Suburban, higher income residents were more than twice as likely to meet recommendations than rural, lower income residents. Significant differences across income levels and urban/rural areas were found for those reporting neighbourhood streets, parks, and malls as places to exercise; fear of injury, being in poor health, or dislike as barriers to exercise and those reporting encouragement from relatives as social support for exercise. Evidence of a positive dose-response relation emerged between number of places to exercise and likelihood to meet recommendations for physical activity. CONCLUSIONS: Both income level and urban rural status were important predictors of adults' likelihood to meet physical activity recommendations. In addition, environmental variables vary in importance across socioeconomic status and urban-rural areas.

Adolescent↗
PubMed2002

Application of a rating system to state clean indoor air laws (USA).

OBJECTIVE: To develop and implement a system for rating state clean indoor air laws. DESIGN: The public health interest of state clean indoor air laws is to limit non-smoker exposure to environmental tobacco smoke (ETS). Current estimates of health risks and methods available for controlling ETS provided a framework for devising a ratings scale. An advisory committee applied this scale to each of seven site specific smoking restrictions and two enforcement related items. For each item, a target score of +4 was identified. The nine items were then combined to produce a summary score for each state. A state that achieved the target across all nine items would receive a summary score of 36 points and be eligible to receive an additional 6 points for exceeding the target on six of the nine items, resulting in a maximum summary score of 42 points. Individual scores were also adjusted to reflect state level preemption measures. Each state's law was evaluated annually from 1993 through 1999. SETTING: USA. MAIN OUTCOME MEASURE: A summary score measuring the extensiveness of the state's clean indoor air law. RESULTS: State laws restricting smoking in the seven individual locations of interest were relatively weak. The overall mean score across the location restrictions ranged from 0.72 in 1993 to 0.98 in 1999. Mean scores were higher for the enforcement items than for the location restrictions. Summary scores ranged from 0 to 20 in 1993 and 0 to 31 in 1994 through 1999. Average summary scores ranged from 8.71 in 1993 to 10.98 in 1999. By the end of 1999, scores increased for 22 states; however, between 1995 and 1997 there were no changes in the summary scores. Three states scored zero points across all years. From 1993 through 1999, there was a 41% increase in the number of states that had in place state level preemption measures. CONCLUSION: The number of newly enacted state clean indoor air laws has remained relatively stagnant since 1995. With a few exceptions, as of the end of 1999, progress in enacting state laws to meet specified public health targets for reducing exposure to ETS was relatively low. Thus, state laws in the USA provide, on average, only minimal protection in specified areas and, given the increase in preemption, are increasingly undermining those passed in localities.

Advisory Committees↗
PubMed2001

Motor-vehicle occupant injury: strategies for increasing use of child safety seats, increasing use of safety belts, and reducing alcohol-impaired driving.

The Task Force on Community Preventive Services has conducted systematic reviews of interventions designed to increase use of child safety seats, increase use of safety belts, and reduce alcohol-impaired driving. The Task Force strongly recommends the following interventions: laws requiring use of child safety seats, distribution and education programs for child safety seats, laws requiring use of safety belts, both primary and enhanced enforcement of safety belt use laws, laws that lower the legal blood alcohol concentration (BAC) limit for adult drivers to 0.08%, laws that maintain the minimum legal drinking age at 21 years, and use of sobriety checkpoints. The Task Force recommends communitywide information and enforcement campaigns for use of child safety seats, incentive and education programs for use of child safety seats, and a lower legal BAC for young drivers (in the United States, those under the minimum legal drinking age). This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, and provides information to help apply the interventions locally.

Accidents, Traffic↗
PubMed2001

The relationship between parental modeling, eating patterns, and dietary intake among African-American parents.

OBJECTIVE: This article examines the relationship between the frequency with which African-American parents report modeling healthful dietary behaviors for their children and parental dietary intake. DESIGN: Cross-sectional, baseline data from a community-based dietary change study to reduce fat intake and increase fruit and vegetable consumption among African-American parents was analyzed to identify role-modeling behaviors. SUBJECTS/SETTING: Subjects were 456 African-American parents who participated in a dietary change study as part of a national parent education group. Participants completed the Parental Dietary Modeling Scale, an eating patterns questionnaire and a food frequency questionnaire. STATISTICAL ANALYSES PERFORMED: Descriptive statistics and stepwise multiple linear regression analyses were conducted. RESULTS: Parental modeling of healthful dietary behavior was associated with the performance low-fat eating patterns (r = 0.48; P < .001), lower dietary fat intake (r = -0.30; P < .001), and higher consumption of fruits and vegetables (r = 0.18; P < .001). APPLICATIONS: The frequency with which parents model healthful dietary behaviors may be associated with parental dietary intake and may have long-term implications for the development of childhood eating patterns. Dietetics professionals need to carefully assess parents' current dietary modeling behaviors and inform parents about how performance of these general behaviors may affect their child's ultimate nutrition health.

Adult↗
PubMed2001

Physician advice and support for physical activity: results from a national survey.

BACKGROUND: It is increasingly well documented that physical activity (PA) is a key preventive behavior and that visits to a physician provide an important opportunity for advice and counseling. This paper reports on physician counseling behaviors regarding PA and other chronic disease risk factors from a national survey. METHODS: A diverse sample of U.S. adults (N=1818), with oversampling of lower-income households, was surveyed about their PA level as well as a host of social, environmental, and physician counseling issues. RESULTS: Overall, 28% of respondents reported receiving physician advice to increase their PA level. Of those who received advice, only 38% received help formulating a specific activity plan and 42% received follow-up support. Patients who received advice and support were more likely to be older, nonwhite, and to have more chronic illnesses and more contact with their doctor. CONCLUSIONS: Physician advice, counseling, and follow-up are important components of the social-environmental supports needed to increase population PA levels. Health system changes, including teaching communication skills, prompts to use those skills, and system changes to support attention to PA, are needed to extend promotion of PA to more patients.

Adolescent↗
PubMed2001

Stage of readiness to exercise in ethnically diverse women: a U.S. survey.

PURPOSE: To assess stage of readiness to exercise and readiness to be physically active in a national survey of women aged 40 yr and over from various racial/ethnic groups (the U.S. Women's Determinants Study). METHOD: The prevalence of each stage was determined and compared across race/ethnicity. In addition, the level of misclassification between self-report of stage of readiness to exercise/be physically active and self-reported participation in specific exercise behavior was evaluated. RESULTS: Data were collected from a total of 2912 U.S. women via telephone survey over a 1-yr period (black 26%, American Indians/Alaskan Natives 25%, Hispanics 23%, and whites 26%). Over half the total sample was staged as currently undertaking regular exercise (maintenance stage, 55%), 25% indicated they were in precontemplation, and 15% were in contemplation stage. Few women were in preparation and action stages. There were statistically significant differences between the minority groups. Specifically, black women (OR 0.53, 95% 0.31-0.91) were less likely to be in the active stages (e.g., preparation, action, maintenance) than Hispanics and Alaskan Native/American Native women, and this was true after controlling for important sociodemographic and health variables (age, education, BMI, and smoking). The additional analysis of a modified stage question developed to assess readiness to be more physically active (150 min.wk(-1)) may have provided inflated results (82% in maintenance), possibly due to the complexity of the questions. The level of misclassification between measures ranged from 5 to 20%. CONCLUSION: These results have important implications for the use of stage of change measures with populations of older ethnically diverse women particularly and the popularity of modifying stage questions to reflect "lifestyle" or moderate-intensity physical activity.

Adult↗
PubMed2001

A prospective investigation of the impact of smoking bans on tobacco cessation and relapse.

BACKGROUND AND OBJECTIVES: To examine the long term impact of workplace smoking bans on employee smoking cessation and relapse. Over three years we studied a total of 1033 current or former smokers (intervention group) employed in smoke-free hospitals and 816 current or former smokers (comparison group) employed in non-smoke-free workplaces. The design of this natural experiment is a prospective cohort study. We randomly selected both hospitals and employees from 12 strata based on hospital size and state tobacco regulations, and sampled employees in the same communities. Main outcome measures were post-ban quit ratio and relapse rate. RESEARCH DESIGN: Between groups comparisons were conducted using the Cochran-Mantel-Haenszel statistic for general association, stratified Cox proportional hazards models, and the CMH analysis of variance statistic based on ranks. McNemar's test and the sign test were used to test for changes over time within each group. RESULTS: Differences in the post-ban quit ratio were observed between intervention and comparison groups (p < or = 0.02). For employees whose bans were implemented at least seven years before survey, the post-ban quit ratio was estimated at 0.256, compared with 0.142 for employees in non-smoke-free workplaces (p = 0.02). After controlling for a variety of factors, time to quit smoking was shorter for the hospital employees (p < 0.001), with an overall relative risk of quitting of 2.3. Contrary to expectations, relapse rates were similar between the groups. CONCLUSION: Employees in workplaces with smoking bans have higher rates of smoking cessation than employees where smoking is permitted, but relapse is similar between these two groups of employees. The results of this investigation have international applicability for policy makers, clinicians, employers, and employees. Countries should review smoking policies in workplaces in light of their own smoking patterns and efforts to deal with environmental tobacco smoke.

Health Behavior↗
PubMed2001

Environmental and policy determinants of physical activity in the United States.

OBJECTIVES: This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior. METHODS: A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled. RESULTS: Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at one's job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity. CONCLUSIONS: An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions.

Adolescent↗
PubMed2000

Dietary heterocyclic amines and the risk of lung cancer among Missouri women.

Heterocyclic amines (HCAs) such as 2-amino-3,8-dimethylimidazo[4,5f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx,), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) are found in meats cooked at high temperatures. In rodents, MeIQx induces lung tumors. The purpose of this study was to investigate lung cancer risk posed by different HCAs in the diet. A population-based case-control study of 593 cases and 623 frequency-matched controls including both nonsmoking and smoking women was conducted in Missouri. An administered food frequency questionnaire with detailed questions on meat consumption, degrees of internal doneness, surface browning/charring, and cooking technique was linked to a database that provided exposure estimates of three HCAs. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. When comparing the 90th and 10th percentiles, significant excess risks were observed for MeIQx (OR, 1.5; CI, 1.1-2.0), but not for DiMeIQx (OR, 1.2; CI, 0.9-1.6) or PhIP (OR, 0.9; CI, 0.8-1.1). MeIQx consumption was associated with increased risk of lung cancer for nonsmokers (OR, 3.6; CI, 1.3-10.3) and light/moderate smokers (OR, 2.1; CI, 1.3-3.3), but not for heavy smokers (OR, 1.0; CI, 0.7-1.5). There was elevated risk with MeIQx intake for subjects with squamous cell carcinomas (OR, 1.9; CI, 1.2-3.1) and "other histological cell types" (OR, 1.6; CI, 1.1-2.5), but not for subjects with small cell carcinomas and adenocarcinomas. Neither DiMeIQx nor PhIP showed an association with smoking categories or lung cancer histology. In conclusion, MeIQx may be associated with lung cancer risk, but DiMeIQx and PhIP are probably not associated with lung cancer risk.

Adenocarcinoma↗
PubMed2000

State youth-access tobacco control policies and youth smoking behavior in the United States.

CONTEXT: State policies aimed at controlling youth access to tobacco are an important component of public health efforts to reduce smoking prevalence among youth and prevent subsequent disease. OBJECTIVES: This study sought to assess the extensiveness of state youth access tobacco control legislation in the United States, describe how state policies changed over a 4-year period, explore how various political and economic characteristics are related to state policies, and determine the relationship of youth smoking behavior to state youth tobacco control policies. DESIGN: This descriptive and correlational study utilized data from multiple national surveillance, economic, and sociodemographic data sets. PARTICIPANTS: All 50 states and the District of Columbia provided economic and political data. A standard tobacco-control policy score was developed by an expert panel for each state. Aggregated state-level measures of youth smoking behavior were provided by 79,491 youth in 33 states and the District of Columbia. MAIN OUTCOME MEASURES: Included were extent of state tobacco control policies and changes over time, relationship between state political and economic characteristics and tobacco control policies, and relationship between state policies and youth smoking behavior. RESULTS: State policy scores increased in variability and in mean value over the 4-year period, from a mean score of 7.2 in 1993 to 9.0 in 1996. State policy scores were significantly correlated with several state political and economic variables. States with more extensive tobacco control policies had significantly lower youth smoking rates. There was some evidence that a strong state tobacco economy may limit the effectiveness of tobacco control policies on youth smoking rates. CONCLUSIONS: It is possible to reliably measure the extent to which states are achieving important public health goals in limiting youth access to tobacco products. Comprehensive state tobacco control policies are important for increasing prevention and cessation of smoking among youth.

Adolescent↗
PubMed2000

Promoting physical activity in rural communities: walking trail access, use, and effects.

INTRODUCTION: Environmental and policy approaches to promote physical activity, such as walking trail construction and promotion, are being widely recommended, yet sparse data exist on their effectiveness. In conjunction with ongoing community-intervention projects in Missouri, walking trails are being built, promoted, and evaluated. Objectives include determining: (1) patterns and correlates of walking, (2) the availability of places to walk and perform other forms of physical activity, (3) the extent of walking trail use and possible effects on rates of physical activity, and (4) attitudes toward the trails and their uses. METHODS: In 12 rural counties in Missouri we used a cross-s ectional telephone survey to ask a population-based sample of residents aged >18 years (n=1269) some standard and specially developed questions about walking behaviors, knowledge, and attitudes. RESULTS: Only 19.5% of respondents were classified as regular walkers. About one third of respondents (36.5%) reported having access to walking trails in their area, and 50.3% reported having access to indoor facilities for exercise. Among persons with access to walking trails, 38.8% had used the trails. Groups who were more likely to have used the walking trails included women, persons with more education, those making $35,000 or more per year, and regular walkers. Among persons who had used the trails, 55.2% reported they had increased their amount of walking since they began using the trail. Women and persons with a high school education or less were more than twice as likely to have increased the amount of walking since they began using the walking trails. CONCLUSIONS: Walking trails may be beneficial in promoting physical activity among segments of the population at highest risk for inactivity, in particular women and persons in lower socioeconomic groups.

Adolescent↗
PubMed2000

Previous lung disease and lung cancer risk among women (United States).

OBJECTIVE: The association between previous lung diseases (PLD) and lung cancer risk has not been studied extensively. We conducted a registry-based case-control study to examine the relation between previous lung diseases and lung cancer among women in Missouri. METHODS: Incident cases (n = 676) were identified through the Missouri Cancer Registry for the period 1 January 1993 to 31 January 1994. Controls (n = 700) were selected through drivers' license files and Medicare files. RESULTS: Whether analyzing all respondents or in-person interviews only, elevated effect estimates were noted for several types of PLD. Elevated relative risk estimates were shown for chronic bronchitis (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.2-2.3), emphysema (OR = 2.7; 95% CI = 1.8-4.2), pneumonia (OR = 1.6; 95% CI = 1.2-2.0), and for all PLDs combined (OR = 1.5; 95% CI = 1.2-1.9). Analysis of only direct interviews did not show a substantial or consistent pattern of change in relative risk estimates. Because PLDs identified close to the time of cancer diagnosis could conceivably be misdiagnosed, resulting from early lung cancer symptoms, we evaluated the effects on risk estimates of a "latency exclusion" of up to three years. When these exclusions were taken into account, ORs remained statistically significantly elevated only for emphysema. CONCLUSION: When earlier epidemiologic findings and underlying biological and genetic factors are taken into account, an association between PLD and lung cancer is plausible.

Adult↗