Perceived Stress and Obesogenic Behavior in Working Adults. Wendy E. Barrington 4/10/09

Transcription

1 Perceived Stress and Obesogenic Behavior in Working Adults Wendy E. Barrington 4/10/09

2 Co-authors: Rachel M. Ceballos 1 Sonia Bishop 1 Nicole Bruner 1 Bonnie A. McGregor 1 Beti Thompson 1,2 Shirley A.A. Beresford 1,3 1 Fred Hutchinson Cancer Research Center, Seattle, Washington 2 Department of Health Services, University of Washington, Seattle, Washington 3 Department of Epidemiology, University of Washington, Seattle, Washington

3 Continued importance of obesity problem Obesity associated with some cancers 1 : Colon Kidney Gallbladder Breast Endometrium One notable intervention success Diabetes Prevention Program 2 higher physical activity and weight loss Need new intervention strategies exploration of obesogenic behavior and environment 1 U.S. Preventive Services Task Force. Screening for Obesity in Adults: Recommendations and Rationale. November Agency for Healthcare Research and Quality, Rockville, MD. 2 Ratner RE, The Diabetes Prevention Program Research. An update on the Diabetes Prevention Program. Endocr Pract Jan-Feb;12 Suppl 1:20-24.

4 Environmental influences Physical and/or social structures in which a being operates (i.e. stressors) Enumeration of built environment: land-use mix, greenspace, food outlets, etc. Aggregation of race, education, household income An individual s perception of those stressors coupled with the appraisal of their ability to cope with those stressors 1 1 Cohen, S., R. Kessler, and L. Gordon, Strategies for measuring stress in studies of psychiatric and physical disorders, in Measuring Stress: A Guide for Health and Social Scientists, S. Cohen, R. Kessler, and L. Gordon, Editors. 1997, Oxford University Press: New York, NY. p

5 Stress has direct physiological consequences Immune Function 1 Decreases number and activity of immune cells (acute stress) Decreases regulatory hormones excessive stimulation of HPA axis (chronic stress) Carcinogenesis (select tumors) 2 Initiation, progression, metastasis Disruption of antiviral defenses DNA repair Cellular aging 1 Herbert, T.B. and S. Cohen, Stress and immunity in humans: a meta-analytic review. Psychosomatic Medicine, : p Cohen, S., D. Janicki-Deverts, and G.E. Miller, Psychological stress and disease. JAMA, (14): p

6 Stress and Behavior Physical Activity 1,2 Decreased activity Failure to return to activity Decreased exercise duration Increased missed opportunities for exercise Diet choice 3 Increases and decreases in food intake High fat High sugar Possibly modified by gender, overweight/obesity, dietary restraint 1 Delahanty, L.M., et al., Psychological predictors of physical activity in the Diabetes Prevention Program. J Am Diet Assoc, : p Stetson, B.A., et al., Prospective evaluation of the effects of stress on exercise adherence in community-residing women. Health Psychology, (6): p Adam, T. and E. Epel, Stress, eating and the reward system. Physiol Behav, : p

7 Aims of the analysis Examine whether association between perceived stress and behavioral factors exists among healthy working adults randomized to participation in a dietary and physical activity intervention to reduce obesity Secondarily, assess whether associations depend on gender

8 Overall Conceptual Framework Environment Individual Gender Physical Structures land-use mix greenspace food outlets walkability Social Structures race culture education SES Perceived Stress Behavioral Factors self-efficacy dietary choices physical activity BMI Environmental Level Confounders Individual Level Confounders

9 Statistical Methods Linear mixed models were conducted including a gender interaction term Fixed effects: perceived stress, age, sex, race, and education Random effect: worksite Separate models for each behavior Fruits and vegetables Fast food Soft drink Physical activity TV Eating while doing another activity Self-efficacy

10 Baseline PACE employee characteristics Subsample (N=34) (n=632) 1 Total (N=34) (n=2847) Mean (SD) Mean (SD) Age (yrs) 44 (12) 42.3 (12) % % Non-Hispanic White College Income > $100k PACE, Promoting Activity and Changes in Eating. 1 N, number of worksites; n, number of employees.

11 Baseline BMI and behaviors by gender of subsample of PACE employees 1 Men Women Mean (SD) Mean (SD) P-value Perceived stress score 11.6 (6.1) 13.6 (6.6) BMI (kg/m 2 ) 28.0 (4.9) 28.4 (7.3) Servings fruits/vegetables per day 2.8 (1.8) 3.3 (1.7) Fast food meals per month 2.8 (4.0) 1.9 (2.4) Free time activity score 31.9 (24.1) 26.5 (21.5) PACE, Promoting Activity and Changes in Eating. 1 N=34; n=632.

12 Perceived stress and dietary behavior

13 Perceived stress and dietary behavior

14 Perceived stress and physical activity

15 Perceived stress and self-efficacy

16 Conclusions Dietary behaviors Higher stress associated with: Eating while doing another activity Lower self-efficacy for dietary monitoring Physical activity Higher stress associated with: Lower leisure-time activity score Lower frequency sweat-inducing activity Lower self-efficacy to do physical activity No differential effects by gender

17 Future Directions Further explore weak relationship with dietary behaviors Restrained eating Explore whether perceived stress is appropriate measure of environment as hypothesized Addition of stress-management techniques may improve the efficacy of obesity prevention interventions Repeat study in more racially or ethnically diverse population

18 Acknowledgements Research efforts were supported by: National Heart Lung & Blood Institute (R01 HL079491) Biobehavioral Cancer Prevention and Control Training Program at the University of Washington (R25 CA092408) Thank you to Stephanie Whisnant for her assistance.

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