Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable tech... more Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitor...
To evaluate the potential utility of a structured dietary intervention to assist bariatric surger... more To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management. Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months. Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30) = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31) = -2.03, P = 0.05]. Change in average daily calorie intak...
Communication in Statistics Simulation and Computation, Jun 23, 2014
ABSTRACT We propose a latent variable model for informative missingness in longitudinal studies w... more ABSTRACT We propose a latent variable model for informative missingness in longitudinal studies which is an extension of Roy's (2003) latent dropout class model. In our model, the value of the latent variable is affected by the missingness pattern and it is also used as a covariate in modeling the longitudinal response. So the latent variable links the longitudinal response and the missingness process. In our model the latent variable is continuous instead of categorical and we assume that it is from a normal distribution. The EM algorithm is used to obtain the estimates of the parameter we are interested in and Gauss-Hermite quadrature is used to approximate the integration of the latent variable (Sammel, et al., 1997). The standard errors of the parameter estimates can be obtained from the bootstrap method or from the inverse of the Fisher information matrix of the final marginal likelihood. Comparisons are made to the mixed model and complete-case analysis in terms of a clinical trial dataset, which is Weight Gain Prevention among Women (WGPW) study (Levine, et al., 2007). We use the generalized Pearson residuals to assess the fit of the proposed latent variable model.
The International journal of eating disorders, Jan 18, 2016
Bariatric surgery results in significant long-term weight loss, albeit with considerable variabil... more Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV). Participants (N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3. The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) (P for all <0.01), and regular eve...
... Marsha D. Marcus, Rena R. Wing, and Joyce Hopkins University of Pittsburgh School of Medicine... more ... Marsha D. Marcus, Rena R. Wing, and Joyce Hopkins University of Pittsburgh School of Medicine ... Nevertheless, binge eating appears to be quite common among obese individuals seeking treatment (Gormally, Black, Daston, & Rardin, 1982; Loro& Orleans, 1981; Marcus, Wing ...
Objective-This study examined the clinical significance of loss of control over eating (LOC) in b... more Objective-This study examined the clinical significance of loss of control over eating (LOC) in bariatric surgery over 24 months of prospective multi-wave follow-ups.
Objective: We used a dimensional measure of mood psychopathology to document lifetime depressive ... more Objective: We used a dimensional measure of mood psychopathology to document lifetime depressive and manic-hypomanic spectrum symptoms in 50 patients with anorexia nervosa (AN). Method: Participants provided demographic information and completed the Self-Report Questionnaire for Mood Spectrum, a 161-item instrument that documents lifetime symptoms, traits, and behaviors characteristic of threshold and subthreshold mood episodes. Analyses focused on the association of depressive and manic-hypomanic component scores with indicators of clinical severity in AN. Results: Lifetime severity of depressive (M[SD] = 39.1[13.9]) and manic-hypomanic (M[SD] = 23.8[12.
This case series describes the development of a novel psychotherapeutic intervention for older ad... more This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five patients with AN aged 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN. V
Objective: The present study was designed to document psychiatric disorders among candidates for ... more Objective: The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and functional health status.
This study was designed to document eating disorder symptoms in a well-defined sample of patients... more This study was designed to document eating disorder symptoms in a well-defined sample of patients with bipolar disorder and to evaluate the relationship of current loss of control over eating (LOC) to demographic and clinical features hypothesized to characterize bipolar patients at risk for disordered eating. Eighty-one patients enrolled in the Bipolar Disorder Center for Pennsylvanians provided demographic information and completed the Structured Clinical Interview for DSM-IV Axis I Disorders. The Eating Disorder Examination was administered by independent clinicians to evaluate current and lifetime eating disorder symptomatology. Twenty-one percent of participants met DSM-IV criteria for a lifetime eating disorder, and 44% reported a history of LOC. Patients who endorsed weekly LOC during the past six months (n = 18) were heavier, had more atypical depressive symptoms, and were more likely to have a lifetime substance use disorder compared to patients in the rest of the sample (n = 63). These findings indicate that eating disorder symptoms are prevalent in patients with bipolar disorder and are associated with obesity and other psychiatric morbidity. Screening for eating disorders in bipolar patients is warranted, as intervention may minimize distress and improve treatment outcome.
To the Editor Drs. Wiezer, Jansen, and Thorell note that 6 months seem to be an unnecessarily lon... more To the Editor Drs. Wiezer, Jansen, and Thorell note that 6 months seem to be an unnecessarily long period of intervention in our study on preparing patients for weight-loss surgery (R01DK077102; PREP Study, ClinicalTrials.gov NCT00623792). In particular, they question whether this duration is necessary if the goal is to reduce surgical complications. This is an excellent question, which we would like to address.
LEVINE, MICHELE D., MARY LOU KLEM, MELISSA A. KALARCHIAN, RENA R. WING, LISA WEISSFELD, LI QIN, A... more LEVINE, MICHELE D., MARY LOU KLEM, MELISSA A. KALARCHIAN, RENA R. WING, LISA WEISSFELD, LI QIN, AND MARSHA D. MARCUS. Weight gain prevention among women. Obesity. 2007;15:1267-1277.
Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little... more Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little is known about the management of obesity among individuals with severe and persistent mental illness. Thus we sought to evaluate the potential utility of a behavioral weight control program for this population. Outpatients receiving psychiatric care at a university medical center who had a body mass index (BMI; weight in kg/[height in m](2)) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 30 and were currently taking antipsychotic medication participated in a 12-week group behavioral weight control program. A medical chart review was conducted for each participant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s body weight over the 10 months prior to beginning the program. A multiple baseline design was used to determine the impact of the intervention on BMI through 12-month posttreatment follow-up. We also assessed self-reported eating behavior, physical activity, and health-related quality of life. Data were collected from October 2000 to July 2003. Among 35 patients who began the program, 29 (83%) completed treatment, with mean (+/- SD) weight loss of 5.04 (+/- 7.52) pounds (p = .001) and improvements in eating, activity, and quality of life. At 3-month posttreatment follow-up (N = 27; 77%), total mean weight loss was 7.14 (+/- 11.47) pounds (p = .003). Results of a longitudinal model based on general estimating equations indicated that, relative to the pretreatment period, BMI decreased significantly during treatment and remained stable through 12-month posttreatment follow-up. Behavioral weight control is a promising approach to the treatment of obesity among outpatients taking antipsychotic medications, but longer and more robust interventions are needed.
The International Journal of Eating Disorders, 1992
... Eating disorders symptomatology in a registry-based sample of women with insulin-dependent di... more ... Eating disorders symptomatology in a registry-based sample of women with insulin-dependent diabetes mellitus. Marsha D. Marcus Ph.D. Assistant Professor 1,* ,; Rena R. Wing Ph.D. Associate Professor 2 ,; Abbas Jawad MS 3 ,; Trevor J. Orchard MBBCh. Associate Professor 4 ...
Because a history of depression has been hypothesized to affect cessation efforts and may be part... more Because a history of depression has been hypothesized to affect cessation efforts and may be particularly problematic for women concerned about weight gain, we sought to document the prevalence of depression history among weight-concerned women smokers and evaluate its effect on treatment outcome. We also evaluated the impact of baseline depressive symptoms and cessation-related changes in symptoms. Women (N = 219) were classified as depression history positive (Major Depressive Disorder [MDD]) (MDD+) or negative (MDD-) according to responses on the Inventory to Diagnose Depression-Lifetime Version. All women received a group-based smoking cessation treatment. Women provided expired-air carbon monoxide samples, completed measures of depressive symptoms, and were weighed at pretreatment and 1, 3, 6, and 12 months after quitting. Fifty-two per cent (n = 115) reported a lifetime history of major depressive disorder. Although MDD+ women were significantly more nicotine dependent, rates of continuous abstinence did not differ between MDD+ and MDD- women. However, MDD+ women were more likely to drop out of treatment prior to quitting. Additionally, depressive symptoms were associated with abstinence irrespective of depression history. Women who reported an increase in depressive symptoms from pre- to post-treatment were significantly less likely to be abstinent post-treatment, suggesting that depressive symptoms are more predictive of outcome than is previous disorder. Moreover, because of the prevalence of depression history among this subgroup of women smokers and its impact on early attrition, additional engagement and retention strategies may be useful.
The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce ... more The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce risk for type 2 diabetes in middle school students. The comprehensive intervention addressed nutrition, physical activity, and behavior in the context of a social marketing-based communications campaign to promote healthy energy balance. One element was a classroom-based program called FLASH (Fun Learning Activities for Student Health). Five FLASH modules were delivered, one per semester. Process evaluation data were collected from teachers at 21 schools and study staff at seven national sites via survey, interview, and in-class observation. Data from the first four modules were evaluated and showed that FLASH was delivered with high fidelity. Sessions that required peer interaction were rated as the most effective in engaging students and promoting knowledge. Study-provided material resources and on-site support were identified as key facilitators. Student misbehavior was viewed as the greatest barrier. Although the high level of support provided by the study is not likely to be replicated in school systems, those developing wellness policies, health curricula, and teacher training programs may benefit from using the evidence-supported, publicly available HEALTHY materials in their efforts to reduce diabetes risk factors in middle school youth.
Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable tech... more Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitor...
To evaluate the potential utility of a structured dietary intervention to assist bariatric surger... more To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management. Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months. Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30) = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31) = -2.03, P = 0.05]. Change in average daily calorie intak...
Communication in Statistics Simulation and Computation, Jun 23, 2014
ABSTRACT We propose a latent variable model for informative missingness in longitudinal studies w... more ABSTRACT We propose a latent variable model for informative missingness in longitudinal studies which is an extension of Roy&#39;s (2003) latent dropout class model. In our model, the value of the latent variable is affected by the missingness pattern and it is also used as a covariate in modeling the longitudinal response. So the latent variable links the longitudinal response and the missingness process. In our model the latent variable is continuous instead of categorical and we assume that it is from a normal distribution. The EM algorithm is used to obtain the estimates of the parameter we are interested in and Gauss-Hermite quadrature is used to approximate the integration of the latent variable (Sammel, et al., 1997). The standard errors of the parameter estimates can be obtained from the bootstrap method or from the inverse of the Fisher information matrix of the final marginal likelihood. Comparisons are made to the mixed model and complete-case analysis in terms of a clinical trial dataset, which is Weight Gain Prevention among Women (WGPW) study (Levine, et al., 2007). We use the generalized Pearson residuals to assess the fit of the proposed latent variable model.
The International journal of eating disorders, Jan 18, 2016
Bariatric surgery results in significant long-term weight loss, albeit with considerable variabil... more Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV). Participants (N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3. The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) (P for all <0.01), and regular eve...
... Marsha D. Marcus, Rena R. Wing, and Joyce Hopkins University of Pittsburgh School of Medicine... more ... Marsha D. Marcus, Rena R. Wing, and Joyce Hopkins University of Pittsburgh School of Medicine ... Nevertheless, binge eating appears to be quite common among obese individuals seeking treatment (Gormally, Black, Daston, & Rardin, 1982; Loro& Orleans, 1981; Marcus, Wing ...
Objective-This study examined the clinical significance of loss of control over eating (LOC) in b... more Objective-This study examined the clinical significance of loss of control over eating (LOC) in bariatric surgery over 24 months of prospective multi-wave follow-ups.
Objective: We used a dimensional measure of mood psychopathology to document lifetime depressive ... more Objective: We used a dimensional measure of mood psychopathology to document lifetime depressive and manic-hypomanic spectrum symptoms in 50 patients with anorexia nervosa (AN). Method: Participants provided demographic information and completed the Self-Report Questionnaire for Mood Spectrum, a 161-item instrument that documents lifetime symptoms, traits, and behaviors characteristic of threshold and subthreshold mood episodes. Analyses focused on the association of depressive and manic-hypomanic component scores with indicators of clinical severity in AN. Results: Lifetime severity of depressive (M[SD] = 39.1[13.9]) and manic-hypomanic (M[SD] = 23.8[12.
This case series describes the development of a novel psychotherapeutic intervention for older ad... more This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five patients with AN aged 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN. V
Objective: The present study was designed to document psychiatric disorders among candidates for ... more Objective: The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and functional health status.
This study was designed to document eating disorder symptoms in a well-defined sample of patients... more This study was designed to document eating disorder symptoms in a well-defined sample of patients with bipolar disorder and to evaluate the relationship of current loss of control over eating (LOC) to demographic and clinical features hypothesized to characterize bipolar patients at risk for disordered eating. Eighty-one patients enrolled in the Bipolar Disorder Center for Pennsylvanians provided demographic information and completed the Structured Clinical Interview for DSM-IV Axis I Disorders. The Eating Disorder Examination was administered by independent clinicians to evaluate current and lifetime eating disorder symptomatology. Twenty-one percent of participants met DSM-IV criteria for a lifetime eating disorder, and 44% reported a history of LOC. Patients who endorsed weekly LOC during the past six months (n = 18) were heavier, had more atypical depressive symptoms, and were more likely to have a lifetime substance use disorder compared to patients in the rest of the sample (n = 63). These findings indicate that eating disorder symptoms are prevalent in patients with bipolar disorder and are associated with obesity and other psychiatric morbidity. Screening for eating disorders in bipolar patients is warranted, as intervention may minimize distress and improve treatment outcome.
To the Editor Drs. Wiezer, Jansen, and Thorell note that 6 months seem to be an unnecessarily lon... more To the Editor Drs. Wiezer, Jansen, and Thorell note that 6 months seem to be an unnecessarily long period of intervention in our study on preparing patients for weight-loss surgery (R01DK077102; PREP Study, ClinicalTrials.gov NCT00623792). In particular, they question whether this duration is necessary if the goal is to reduce surgical complications. This is an excellent question, which we would like to address.
LEVINE, MICHELE D., MARY LOU KLEM, MELISSA A. KALARCHIAN, RENA R. WING, LISA WEISSFELD, LI QIN, A... more LEVINE, MICHELE D., MARY LOU KLEM, MELISSA A. KALARCHIAN, RENA R. WING, LISA WEISSFELD, LI QIN, AND MARSHA D. MARCUS. Weight gain prevention among women. Obesity. 2007;15:1267-1277.
Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little... more Antipsychotic medications are associated with weight gain and metabolic dysregulation, yet little is known about the management of obesity among individuals with severe and persistent mental illness. Thus we sought to evaluate the potential utility of a behavioral weight control program for this population. Outpatients receiving psychiatric care at a university medical center who had a body mass index (BMI; weight in kg/[height in m](2)) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 30 and were currently taking antipsychotic medication participated in a 12-week group behavioral weight control program. A medical chart review was conducted for each participant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s body weight over the 10 months prior to beginning the program. A multiple baseline design was used to determine the impact of the intervention on BMI through 12-month posttreatment follow-up. We also assessed self-reported eating behavior, physical activity, and health-related quality of life. Data were collected from October 2000 to July 2003. Among 35 patients who began the program, 29 (83%) completed treatment, with mean (+/- SD) weight loss of 5.04 (+/- 7.52) pounds (p = .001) and improvements in eating, activity, and quality of life. At 3-month posttreatment follow-up (N = 27; 77%), total mean weight loss was 7.14 (+/- 11.47) pounds (p = .003). Results of a longitudinal model based on general estimating equations indicated that, relative to the pretreatment period, BMI decreased significantly during treatment and remained stable through 12-month posttreatment follow-up. Behavioral weight control is a promising approach to the treatment of obesity among outpatients taking antipsychotic medications, but longer and more robust interventions are needed.
The International Journal of Eating Disorders, 1992
... Eating disorders symptomatology in a registry-based sample of women with insulin-dependent di... more ... Eating disorders symptomatology in a registry-based sample of women with insulin-dependent diabetes mellitus. Marsha D. Marcus Ph.D. Assistant Professor 1,* ,; Rena R. Wing Ph.D. Associate Professor 2 ,; Abbas Jawad MS 3 ,; Trevor J. Orchard MBBCh. Associate Professor 4 ...
Because a history of depression has been hypothesized to affect cessation efforts and may be part... more Because a history of depression has been hypothesized to affect cessation efforts and may be particularly problematic for women concerned about weight gain, we sought to document the prevalence of depression history among weight-concerned women smokers and evaluate its effect on treatment outcome. We also evaluated the impact of baseline depressive symptoms and cessation-related changes in symptoms. Women (N = 219) were classified as depression history positive (Major Depressive Disorder [MDD]) (MDD+) or negative (MDD-) according to responses on the Inventory to Diagnose Depression-Lifetime Version. All women received a group-based smoking cessation treatment. Women provided expired-air carbon monoxide samples, completed measures of depressive symptoms, and were weighed at pretreatment and 1, 3, 6, and 12 months after quitting. Fifty-two per cent (n = 115) reported a lifetime history of major depressive disorder. Although MDD+ women were significantly more nicotine dependent, rates of continuous abstinence did not differ between MDD+ and MDD- women. However, MDD+ women were more likely to drop out of treatment prior to quitting. Additionally, depressive symptoms were associated with abstinence irrespective of depression history. Women who reported an increase in depressive symptoms from pre- to post-treatment were significantly less likely to be abstinent post-treatment, suggesting that depressive symptoms are more predictive of outcome than is previous disorder. Moreover, because of the prevalence of depression history among this subgroup of women smokers and its impact on early attrition, additional engagement and retention strategies may be useful.
The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce ... more The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce risk for type 2 diabetes in middle school students. The comprehensive intervention addressed nutrition, physical activity, and behavior in the context of a social marketing-based communications campaign to promote healthy energy balance. One element was a classroom-based program called FLASH (Fun Learning Activities for Student Health). Five FLASH modules were delivered, one per semester. Process evaluation data were collected from teachers at 21 schools and study staff at seven national sites via survey, interview, and in-class observation. Data from the first four modules were evaluated and showed that FLASH was delivered with high fidelity. Sessions that required peer interaction were rated as the most effective in engaging students and promoting knowledge. Study-provided material resources and on-site support were identified as key facilitators. Student misbehavior was viewed as the greatest barrier. Although the high level of support provided by the study is not likely to be replicated in school systems, those developing wellness policies, health curricula, and teacher training programs may benefit from using the evidence-supported, publicly available HEALTHY materials in their efforts to reduce diabetes risk factors in middle school youth.
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Papers by Marsha Marcus