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J. Umbrak, M.B. B.A.O., M.B.B.Ch., Ph.D.

Assistant Professor, University of Alaska at Fairbanks

Nader and colleagues (1989) conducted a nutrition and physical activity program for Anglo-American and Mexican American families with children in fifth and sixth grades; the program improved dietary habits but did not succeed in increasing physical activity levels, although participation in the program was high. Another family-based program, a 14-week intervention for African American families that included educational sessions and twiceweekly fitness center activities, had low attendance and did not increase physical activity (Baranowski et al. The exercise program consisted of several 1-hour aerobic sessions offered during the week. Zuni Indians who were trained in exercise and group leadership methods helped coordinate the People Who Are Overweight Being overweight increases the risk of developing chronic diseases (see Chapter 4). Results of interventions to promote physical activity for weight loss have been mixed (Perri et al. The Building Your Fitness Futures program was a 4-week adult education class that focused on how to develop a regular exercise program. The Wise Weighs programs was an 8-week adult education class that emphasized weight management strategies related to diet and exercise. The Building Your Fitness Futures and the Wise Weighs programs resulted in only small weight loss that was not significant after 1 year. The correspondence course resulted in significantly greater weight loss among participants with $60 incentives than among those with $5 incentives. Wing (1995) suggests that there are three time periods during which interventions to prevent weight gain might be most effective: in the years between ages 25 and 35 years, in the peri-menopausal period for women, and in the year following successful weight loss. The participants (approximately two-thirds women) were randomly assigned to either the intervention group (n = 103) or the no-contact control group (n = 108). This program was for normal-weight adults and included monthly newsletters and four 232 Understanding and Promoting Physical Activity classes emphasizing diet and regular exercise as well as a financial incentive component linked to weight maintenance. The intervention group lost 2 pounds on average over the course of the year and were significantly less likely to gain weight than the control group (82 percent vs. Most participants in this study reported becoming physically active at the urging of their physicians; several others were motivated by personal interest in health maintenance, and some were encouraged by family members. Mall walkers maintained a regular routine, showing up at the same time each day, walking in pairs or small groups, and then adjourning to a mall eatery for coffee or breakfast. Interviews revealed that participants perceived mall walking as meaningful "work" to be doing during retirement. A need for socializing with others, a sense of belonging to a community of mall walkers, and the safe environment of the mall were other factors contributing to adherence. Study researchers recommended that community-based physical activity programs try to replicate various aspects of work, such as keeping attendance records and providing occasional recognition or acknowledgment of a job well done (such as pins, certificates, or celebrations). Older Adults Many of the diseases and disabling conditions associated with aging can be prevented, postponed, or ameliorated with regular physical activity (see Chapter 4). The few interventions that have been tested to increase physical activity levels among older adults show generally positive results. The 1990 Australian Heart Week campaign reviewed earlier resulted in a twofold increase in walking among adults over 50 years of age (Owen et al. Retirees in the study by Fries (1993), also discussed earlier, showed significantly greater improvements in physical activity in year 2 than did persons in the control group. Participants in a longitudinal study of Medicare recipients (n = 1,800) who belonged to a health maintenance organization were randomly assigned to a preventive care or a control group (Mayer et al. Participants received recommended immunizations, completed a health risk appraisal, received face-to-face counseling that included goal setting, received follow-up telephone counseling, and participated in educational sessions on health promotion topics. A focus on physical activity was a priority in goal-setting discussions; 42 percent of participants selected increasing physical activity as their goal. Members of both groups were largely white, well educated, and generally had above-average incomes. The prevalence of physical activity was high in both groups at baseline; approximately 60 percent reported getting regular exercise. At 1 year, the intervention group showed a significant 7 percent increase in self-reported physical activity. Much of the published research on physical activity describes researcher-initiated interventions.

Nutritional and physiological responses of growing pigs exposed to a diurnal pattern of heat stress. The tolerance of sheep for mixtures of sodium chloride and magnesium chloride in the drinking water. Prepared for Agriculture and Agri-Food Canada-Prairie Farm Rehabilitation Administration. The influence of protein intake on water balance, flow rate and apparent digestibility of nutrients at the distal ileum in growing pigs. Effect of dietary calcium and phosphorus levels on magnesium utilization in sheep. Effect of selenite on the toxicity of dietary methyl mercury and mercuric chloride in the rat. Relationship of plasma calcium and phosphorus to the shell quality of laying hens receiving saline drinking water. Effects of dietary iron on performance and mineral utilization in lambs fed a forage based diet. Plasma parathyroid hormone and calcitonin levels in hypocalcaemic magnesium deficient calves. The effect of manganese and other trace elements on the metabolism of calcium and phosphorus during early lactation. Diversity, frequency, and persistence of Escherichia coli O157 strains from range cattle environments. The physiological basis of poor eggshell quality in laying hens: the effect of saline drinking water on electrolyte balance and renal function. The effect of oral ammonium molybdate and sodium sulfate given to lambs with high liver copper concentrations. Effect of water softening, watering devices, and dietary salt level on the performance of caged Single Comb White Leghorn laying hens. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Results of a longitudinal study of the prevalence of Escherichia coli O157:H7 on cow-calf farms. Comparative effects of selenium on metabolism of methylmercury by 8chickens and quail: Tissue distribution and transfer into eggs. Metabolism of mercury, administration as methylmercuric chloride or mercuric chloride by lactating ruminants. Distribution of mercury among components of eggs following the administration of methylmercuric chloride to chickens. Accumulation and depletion of cadmium and lead in tissues and milk of lactating cows fed small amounts of these metals. Shedding of Escherichia coli O157:H7 in dairy cattle housed in a confined environment following waterborne inoculation. Relative effects of feeding hay atmospherically contaminated by fluoride residue, normal hay plus calcium 149 References fluoride, and normal hay plus sodium fluoride to dairy heifers. The effects of sulphate removal from drinking water on the plasma and liver copper and zinc concentrations of beef cows and their calves. A review of copper status of cattle in Canada and recommendations for supplementation. Abnormal bone development and lameness associated with secondary copper deficiency in young cattle. Performance of high producing cows offered drinking water of high and low salinity in the Arava desert. Influence of dietary iron and phosphorus on performance, tissue mineral composition and mineral absorption in steers. Influence of graded levels of dietary iron as ferrous sulphate, on performance and tissue mineral composition of steers. Effects of organic and inorganic sulfur on the availability of dietary copper to sheep. The role of organic sulfur in the copper-molybdenum-S interrelation ship in ruminant nutrition. The role of a soil x dietary sulfur interaction in the impairment of copper absorption by soil ingestion in sheep.

Although the effects of the nutritional and physical activity components of this intervention cannot be separated, the study does show that the risk for developing hypertension among persons who are at high risk for the disease can be lowered by weight loss and improvements in dietary and physical activity practices. Like physical inactivity, low cardiorespiratory fitness in middle age is associated with increased risk for high blood pressure. After adjustment for sex, age, baseline blood pressure, and body mass index, persons with low cardiorespiratory fitness had a 52 percent higher risk of later developing high blood pressure than their fit peers (Blair et al. Taken together, the cohort studies show that physical inactivity is associated with an increased risk of later developing hypertension among both men and women. Three of the studies had more than two categories of physical activity for comparison, and each demonstrated a dose-response gradient between amount of activity and degree of protection from hypertension. Point estimates for quantification of risk suggest that those least physically active have a 30 percent greater risk of developing hypertension than their most active counterparts. Several randomized controlled trials have been conducted to determine the effects of exercise on blood pressure in people with elevated blood pressure levels. Thirteen High Blood Pressure High blood pressure is a major underlying cause of cardiovascular complications and mortality. Organ damage and complications related to elevated blood pressure include left ventricular hypertrophy (which can eventually lead to left ventricular dysfunction and congestive heart failure), hemorrhagic stroke, aortic aneurysms and dissections, renal failure, and retinopathy. Prospective observational studies relating physical activity level or cardiorespiratory fitness to risk of hypertension are summarized in Table 4-4. One found later development of hypertension to be inversely related to the reported number of hours per week of participation in sports or exercise while in college (Paffenbarger, Thorne, Wing 1968). Follow-up of a different cohort of male college alumni similarly showed the least active men to have a 30 percent increased risk of developing hypertension (Paffenbarger et al. Some of the studies were conducted with persons with defined hypertension (> 140/90 mm Hg), and others were conducted with persons with high normal blood pressure. Three trials have specifically examined the effect of different intensities of exercise on blood pressure. The pretest-to-posttest decreases in systolic and diastolic blood pressure in the lower-workload group were significant (9 mm Hg/6 mm Hg), but those in the higher-intensity group were not (3 mm Hg/5 mm Hg). A similar reduction in 24-hour blood pressure was observed for both training intensities (5 mm Hg decrease), but diurnal patterns of reduction were different. These trials provide some evidence that moderateintensity activity may achieve a similar, or an even greater, blood-pressure-lowering effect than vigorous-intensity activity. Because few studies have directly addressed the intensity question, however, the research base is not strong enough to draw a firm conclusion about the role of activity intensity in lowering blood pressure. It is not clear, for example, how the findings could have been affected by several issues, such as use of antihypertensive medications, changes in body weight, lack of direct interventioncontrol comparisons, dropout rates, and total caloric expenditure. Postulated mechanisms involve advantageous effects on atherosclerosis, plasma lipid/lipoprotein profile, blood pressure, availability of oxygenated blood for heart muscle needs (ischemia), blood clotting (thrombosis), and heart rhythm disturbances (arrhythmias) (Haskell 1995; Leon 1991a; Gordon and Scott 1991). The formation of atherosclerotic plaques is increased at sites where the blood vessel lining is injured, which may occur in areas where blood flow is uneven. An inflammatory reaction leads to the formation of atherosclerotic plaques in the wall of the artery. In animal studies, exercise has been seen to protect against the effects of excess cholesterol and other contributors to the development of atherosclerosis (Kramsch et al. There is also an inverse relationship between cardiorespiratory fitness and ultrasound-measured severity of atherosclerosis in neck arteries to the head (carotid arteries) (Rauramaa et al. Blood pressure is directly proportional to cardiac output and total resistance in the peripheral blood vessels.

Of the 1,433 articles that mentioned Trump or Clinton, 291 were devoted to scandals or other personal matters, while only 70 mentioned policy. In other words, comparing the two datasets, the number of Personal/Scandal stories for every Policy story ranged from 3. Table 1: Front page New York Times stories classified as about the campaign that focused primarily on personal scandals, policy, and miscellaneous matters (see text for coding). Under President Trump, the Affordable Care Act is being actively undermined, environmental and consumer protections are being rolled back, international alliances and treaties are being threatened, and immigration policy has been thrown into turmoil, among other dramatic changes. If ever there was an election in which the news media had an obligation to inform citizens of the substantive policy implications of their choice, the election of 2016 should have been such an election. And yet only five out of 150 front page articles that the New York Times ran over the last, most critical months of the election even attempted to make these comparisons evident to their readers, while only ten even mentioned policy details of either candidate. The level of coverage becomes truly astounding when juxtaposed with the coverage of all policy issues combined. Setting scandals aside for a moment, arguably the most salient policy issue of the election campaign was the success or failure of Obamacare. As Figure 3 shows, the first article, on October 3, strikes a much gloomier note than the Upshot articles above, stating "Mr. Further, none of the articles mention the Medicaid expansion, which has proven to be one of the most popular parts of the bill. Instead, the articles draw their negative inferences from the small fraction of Obamacare users who paid full price in the markets, while ignoring all the features that have made it so popular postelection. All four front-page articles that touch on the Affordable Care Act (aka ObamaCare), published on (from left to right) October 3, 25, 26, 27. What they would have learned about was that both candidates were plagued by scandal: Hillary Clinton over her use of a private email server for government business while Secretary of State and also allegations of possible conflicts of interest in the Clinton Foundation; and Trump over his failure to release his tax returns, his past business dealings, Trump University, the Trump Foundation, accusations of sexual harassment and assault, and numerous misogynistic, racist, and otherwise insensitive or offensive remarks. In retrospect, it seems clear that the Times-along with essentially all its peer organizations-made the mistake of assuming that a Clinton victory was inevitable, and were setting themselves as credible critics of the next administration (Silver 2017a). Possibly this mistake arose from the failure of journalists to get of their "hermetic bubble" as some have asserted (Spayd 2017). Possibly it was their misinterpretation of available polling data, which showed all along that a Trump victory, albeit unlikely, was far from inconceivable (Silver 2017b; Watts 2017). These were understandable mistakes, but 32 Watts and Rothschild they were still mistakes. To be fair, journalists were not the only community to be surprised by the outcome of the 2016 election-a great many informed observers, possibly including the candidate himself, failed to take the prospect of a Trump victory seriously. Also to be fair, the difficulty of adequately covering a campaign in which the "rules of the game" were repeatedly upended must surely have been formidable (Hepworth et al. That said, one could equally argue that Facebook could not have been expected to anticipate the misuse of its advertising platform to seed fake news stories. And one could just as easily argue that the difficulties facing tech companies in trading off between complicity in spreading intentional misinformation on the one hand, and censorship on the other hand, are every bit as formidable as those facing journalists trying to cover Trump. We have no doubt that journalists take their mission to provide their readers with the information they need "in order to make decisions regarding their lives, and their local and national communities. We note, however, that this mission implicitly assumes that journalist are passive observers of events rather than active participants whose choices about what to cover and how to cover it do not meaningfully influence the events in question. Given the disruption visited upon the print news business model since the beginning of the 21st century, journalists can perhaps be forgiven for seeing themselves as helpless bystanders in an information ecosystem that is increasingly centered around social media and search. But even if the news media has ceded much of its distribution power to technology companies, its longstanding ability to "set the agenda" (McCombs and Shaw 1972)-that is, to determine what counts as news to begin with-remains formidable. To check that our conclusions regarding coverage of the campaign were not badly biased by restricting our sample to 33 Watts and Rothschild the front page only, we also coded the entire corpus of all articles published on nytimes. Note: this criterion that would include all campaignrelated articles but might also include potentially non-campaign related articles. Next, we compiled a list of words (details below) delineating three categories of article: campaign (focused on horse race and how people react to events); policy (focused on a policy issue); and personal/scandal.

The message in menthol-related advertisements at that time and since has stressed "cool" lifestyles and young people having lots of fun together, both important themes for youth and young adults. The lower pH of the snuff in this product decreases nicotine absorption Monograph 19. The Role of the Media in the mouth and therefore reduces the harshness of the taste for the new user. Industry documents describe a "graduation process" in which youth begin smokeless tobacco use with Skoal Bandits, and then, after developing tolerance to the modest bioavailability of its nicotine content, they graduate to higher nicotine brands. Marketing activities have targeted college students (on campuses and at warm-weather student vacation sites), and advertisements have provided instructions on how to use the products. While the western imagery, cowboys, and horses would appeal to the youngest child, this campaign features the themes of independence and freedom from authority- both messages that address important issues for adolescents. The individual events, programs, and organizations are listed in a detailed report authored by Siegel. Cummings and colleagues concluded that this shift was in part an effort by the tobacco industry to dodge claims that tobacco marketing targeted youth, despite stated plans to promote cigarettes near high schools and other youth-oriented locations. There has been keen tobacco industry interest in the 18- to 25-year-old target population because this age range is a time of transition and experimentation and because most new smokers stay with the brand they first use regularly. Tobacco marketing has been aimed at "tunnels of influence" through which young adults travel frequently and in which they are experimenting and experiencing changes in their lives, such as colleges, fraternities, bars, and the military. Tobacco sponsorship of promotions at urban bars appears to have risen in the 1990s. In the first six months of 2004, more than 10,000 tobacco-sponsored bar nights were announced in California, many representing locations where the marketing staff would stop for a few minutes to see if any potential smokers might be interested in a free sample. This is referred to as "stealth marketing," "buzz marketing," or "undercover marketing,"106 a subject discussed in more detail in chapter 4. In both cases, Skoal and/or Copenhagen booths (see page 144 for an example) can pass out promotional literature, coupons, and even free samples, as long as distribution is restricted to adults. Racial and Ethnic Populations Racial and ethnic populations in the United States represent a wide array of opportunities for growth in sales of tobacco products as well as support from community leaders for industry legislative initiatives. Prevalence of tobacco use among some of these populations is higher than among the general population, and quit rates are lower. African Americans Tobacco advertising and promotion to African Americans have been marked by special products, imagery, themes, and locations designed to reach and appeal to black audiences. Around 1900, the American Tobacco Company advertised Bull Durham smoking tobacco with the caricatured images of blacks that were commonly used in that era. The Role of the Media advertisements in predominantly AfricanAmerican publications since the 1940s, when Philip Morris first recognized the significance of this market. They also found that the models and spokespersons in Ebony were predominantly black. Special tobacco products, mostly menthols, were developed and promoted originally to women and then increasingly to African Americans. Reynolds stated, in a speech in 1988, that, "Where menthol smokers make up only 29 percent of the general market, almost 70 percent of Black smokers choose a menthol brand. When observations were conducted by tobacco control advocates in bars in southern California, materials from a Kool bar night were collected, including Kool bar napkins, a lighter with a green flame, packs of Kool cigarettes, coupons, and a Kool Mixx plastic bag. These materials served as evidence that permitted court actions in three states to halt distribution of some of the promotional items (California Department of Justice, Standing Up to Targeted Marketing-the Uptown Protest One product designed to be promoted to African Americans, Uptown cigarettes, was developed by R. It was intended to compete with Newport (Lorillard), which had an 80% share of the young adult African-American market. Package design and colors were tested with this market in mind, with tar and nicotine levels that were higher than in most other menthol brands. While Newport advertising portrayed a fun, stylish, mainstream sensibility, Uptown focused more on status, style, and premium quality. African-American community groups organized a coalition to oppose this introduction of Uptown, forcing R.