The Women's Health Trial Feasibility Study in Minority Populations: design and baseline descriptions.

The Women's Health Trial: Feasibility Study in Minority Populations (WHT:FSMP), a randomized trial of 2208 women, was conducted to investigate three questions. First, can women from minority and low-socioeconomic-status populations be recruited in numbers sufficient to evaluate a dietary intervention designed to lower fat intake. Second, the efficacy of a low fat, increased fruit/vegetable/ grain product intervention for reducing fat consumption.

Do beliefs, knowledge, and perceived norms about diet and cancer predict dietary change?

Objectives: We hypothesized that belief in an association between diet and cancer, knowledge of dietary recommendations and food composition, and perceived norms would predict healthful dietary changes.

Methods: Data are from a population-based sample of Washington State residents (n = 607). Psychosocial constructs measured at baseline (1989/90) were used to predict changes in dietary practices, fat intake, fiber intake, and weight over 3 years.

Estimating relative risk functions in case-control studies using a nonparametric logistic regression.

The authors describe an approach to the analysis of case-control studies in which the exposure variables are continuous, i.e., quantitative variables, and one wishes neither to categorize levels of the exposure variable nor to assume a log-linear relation between level of exposure and disease risk.

Nevi and migration within the United States and Canada: a population-based cross-sectional study.

A survey to ascertain factors associated with benign melanocytic nevi or moles was conducted among randomly-selected White adults (aged 18 to 50 years) in Washington State (United States). Participants of the telephone interview in 1990-91 were questioned about lifetime places of residence and constitutional factors. Subjects counted raised nevi on their arms at the end of the survey.

Low-fat diet practices of older women: prevalence and implications for dietary assessment.

Objective: To evaluate the importance of information on low-fat diet practices and consumption of reduced-fat foods for accurate assessment of energy and fat intakes using a semiquantitative food frequency questionnaire (FFQ).

Subjects: Subjects were 7,419 women, aged 50 to 79 years, who filled out an FFQ as part of eligibility screening for a diet modification component and/or a hormone replacement trial in a multicenter study of chronic disease prevention in postmenopausal women (Women's Health Initiative).

Statistical Analysis: For 26 FFQ questions, we recoded the low-fat diet choices of participants to a high-fat counterpart and recalculated energy and fat intakes.

Constitutional factors and sun exposure in relation to nevi: a population-based cross-sectional study.

A survey of benign melanocytic nevi (moles), suspected precursors or markers for melanoma, was conducted in Washington State among 717 randomly selected 18- to 50-year-old white adults who participated in a telephone interview in 1990-1991. Participants were questioned about constitutional factors, time spent in the sun, and severe sunburns over three time periods and were asked to count the raised nevi on both their arms. Logistic regression was used to examine the risk for 2+ nevi compared with none.

A pilot study of DNA aneuploidy in colorectal adenomas and risk of adenoma recurrence.

This case-control study examined whether DNA aneuploidy in colorectal adenomas is a risk factor for subsequent adenoma recurrence. Cases (recurrent polyp formers) were defined as persons with diagnoses of new adenomas at 2 colonoscopies following the index (first) adenoma diagnosis; controls were persons with no new adenomas at a follow-up at least 1 year after the index diagnosis. Cases (n = 22) and up to 3 controls (n = 29) were matched for factors known to be associated with polyp recurrence or aneuploidy: (a) age; (b) histology; (c) number of index polyps; and (d) size of largest index polyp.

Physician recommendations for dietary change: their prevalence and impact in a population-based sample.

A random-digit-dialing survey to examine the prevalence, content, and impact of physician dietary recommendations in a representative population-based sample of Washington State residents was administered to 1972 persons aged 18 years and older. Twenty percent of those surveyed received a physician's recommendation for dietary change in the previous year. The most common recommendations were to decrease intake of cholesterol, calories, and red meat and to increase intake of vegetables and fiber.

Psychosocial correlates of healthful diets: baseline results from the Working Well Study.

Background: This report examines psychosocial factors related to selection of healthful diets. Understanding why people select healthful diets can lead to rational design and evaluation of nutrition intervention programs.

Methods: Data are from 16,287 respondents to the baseline survey for the Working Well Trial, a randomized, controlled trial of worksite-based health promotion.

Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma.

Adenocarcinomas of the esophagus and gastric cardia were once rare. However, for unknown reasons, their incidence has been increasing rapidly over the past 15 years in the United States and parts of Western Europe. In contrast, the incidence of esophageal squamous cell carcinomas has remained relatively constant.

Evaluating community-based nutrition programs: comparing grocery store and individual-level survey measures of program impact.

Background: This paper examines whether an "environmental indicator"--a survey of grocery store product displays--can provide a realistic alternative to individual-level telephone surveys for the evaluation of community-based nutrition programs.

Methods: Telephone and grocery store measures were used separately to evaluate three community-level dietary interventions that were part of the Kaiser Family Foundation Community Health Promotion Grants Program (CHPGP). Both surveys were conducted in the three intervention and seven control communities at three points in time: 1988, 1990, and 1992.

Assessing the validity of a survey of the restaurant health promotion environment.

Our primary question was whether a telephone survey of restaurant personnel could provide accurate community-level measures of the restaurant health promotion environment. An obvious concern was that restaurant personnel might exaggerate the extent to which their establishment had a positive health promotion environment. Comparison with the most obvious "gold standard"--direct observation--showed fairly accurate reporting about nonsmoking seating arrangements, but restaurant personnel exaggerated the extent to which menu items were designated as low in fat.

Assessing change in diet-intervention research.

In nutrition-intervention research, it is important to consider the sensitivity of dietary assessment instruments to the changes in nutrient intake or dietary behavior under study. This presentation describes a measure called "responsiveness," an index of an instrument's sensitivity to change. Illustrations of this measure are from two randomized dietary-intervention trials that targeted reductions in fat intake: the Women's Health Trial (WHT), a trial to test whether fat reduction would reduce the risk of breast cancer, and the Eating Patterns Study (EPS), a trial to evaluate a self-help booklet to promote dietary change.

Stages of change in adopting healthy diets: fat, fiber, and correlates of nutrient intake.

The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial.

Work-site smoking policies: their population impact in Washington State.

This article presents data from a population-based, random-digit dialing telephone survey of 1228 employed adults in Washington State, conducted 1989 through 1990. Eighty-one percent of men and 91% of women reported work-site smoking restrictions. Employees in work sites with no-smoking policies were less likely to be current smokers; men in work sites with policies restricting smoking smoked fewer cigarettes on both workdays and nonworkdays.

Effects of enhanced calling efforts on response rates, estimates of health behavior, and costs in a telephone health survey using random-digit dialing.

Public health researchers frequently rely on random-digit dialing (RDD) telephone surveys in monitoring trends in health behavior and evaluating health promotion interventions. RDD response rates have declined during the past decade, and cost-effective methods to increase response rates are needed. The authors evaluated two levels of enhanced calling efforts in an RDD survey of cancer-related health behavior in the State of Washington.

Development and validation of measures of psychosocial factors influencing fat- and fiber-related dietary behavior.

Background: Understanding factors influencing food choices is likely to enhance the effectiveness of strategies to promote healthy eating patterns. This article describes the process used to develop measures of psychosocial factors related to eating patterns in the Working Well project.

Methods: Working Well is a multicenter controlled trial of worksite health promotion interventions, including a nutrition intervention aimed at promoting low-fat, high-fiber eating.

Can measures of the grocery store environment be used to track community-level dietary changes?

Background: This article examines whether an in-store unobtrusive survey of grocery store product displays can be used to track community-level dietary behavior.

Methods: The survey was conducted in 12 western communities two different times to measure two aspects of the grocery store environment: (a) the relative availability of low-fat and high-fiber products and (b) the amount of store-provided health-education information. Self-reported dietary intake of residents was obtained in the same 12 communities using a telephone survey.

Environmental indicators: a tool for evaluating community-based health-promotion programs.

We propose using a class of community-level measures--environmental indicators--as part of the evaluation of community-based health-promotion programs. Community-level measures of health-related behavior can be divided into three conceptual categories. The first two categories comprise statistical aggregates (e.

How women's adopted low-fat diets affect their husbands.

Objectives: One way of promoting a reduction in dietary fat intake is by changing the diet of family members. This study investigated the long-term effects of a low-fat dietary intervention on husbands of women who participated in the Women's Health Trial (WHT).

Methods: An average of 12 months after the end of the WHT, a randomly selected sample of participants' husbands was sent dietary and health questionnaires as part of a follow-up study of the maintenance of the low-fat diet among WHT participants.

Maintenance of a low-fat diet: follow-up of the Women's Health Trial.

This report examines the maintenance of a low-fat diet 1 year on average after the completion of intervention sessions among participants in the Women's Health Trial (WHT). The WHT was a randomized controlled trial of the feasibility of adoption of a low-fat diet among women of moderate or increased risk of breast cancer, conduced in Seattle, Houston, and Cincinnati in 1985-1988. The women randomized to the low-fat diet attended an intensive dietary intervention program for 5-37 months.

Correlates of maintenance of a low-fat diet among women in the Women's Health Trial.

Background: The Women's Health Trial (WHT) was a feasibility study for a randomized controlled trial designed to test the hypothesis that a reduction in dietary fat reduces breast cancer incidence among women age 45 to 69. Between 1984 and 1988, 2,064 women participated in its two phases.

Methods: A follow-up study of 525 women who were randomized to receive the WHT dietary intervention program was conducted to assess maintenance of the diet 1 year on average after the trial ended.