OREGON STATE UNIVERSITY

college of public health and human sciences

Improving confidence keeps breast cancer survivors exercising

CORVALLIS, Ore. – More than 40 percent of older breast cancer survivors are insufficiently active after leaving a supervised program. But new research shows that those women who developed behavioral skills such as self-confidence and motivation during their program were far more likely to continue exercising on their own.

Regular exercise may reduce the risk of breast cancer recurrence and breast cancer-related mortality, experts say, making it crucial to effectively target breast cancer survivors who do not engage in regular physical activity for interventions.

Researchers at Oregon State University partnered with researchers at Oregon Health and Science University who had conducted a clinical trial to understand the benefits of a 12-month supervised exercise program in 69 older breast cancer survivors. The goal was to discover what factors influenced participants’ ability to follow-through and continue exercising after the supervised program ended.

They found that breast cancer survivors with higher self-efficacy, or confidence to overcome exercise-related barriers (such as being too tired), were far more likely to continue exercising on their own. Those with higher self-efficacy scores were 10 percent more likely to be physically active six months after the intervention than those with lower scores.

The results of the study are published in the October issue of the journal Supportive Care in Cancer. It is the first study to assess predictors of behavior after a supervised exercise program in older breast cancer survivors.

Paul Loprinzi, lead author of the study, was a doctoral student at OSU when he did the research. Loprinzi, who is now a faculty member at Bellarmine University, said the good news is that behavioral skills to increase self-efficacy can be taught.

“We can teach breast cancer survivors how to enlist the support of others and how to identify exercise-related barriers, as well as provide proven strategies for them to overcome those barriers,” Loprinzi said.

The researchers said everyone should meet physical activity guidelines – and it can be even more crucial for breast cancer survivors. Loprinzi said exercise helps reduce common side effects of cancer treatment, such as fatigue, depression, decreased muscular strength and weight gain.

“Especially important is minimizing weight gain after breast cancer treatment because excessive weight gain can increase the risk of developing reoccurring breast cancer,” he said.

Bradley Cardinal, professor of exercise science at OSU and one of the study’s authors, said instructors who administer supervised exercise programs for breast cancer survivors can help by modeling behavior.

“When people who lead the classes are cancer survivors themselves, this can help because they become a role model,” he said. “Also, they can help prepare the participants for that time when they have to exercise on their own.”

Cardinal said in a past study done in his lab, he found several ways to develop behavioral skills that help people succeed at regular exercise. For instance, “counter-conditioning,” or substituting a positive behavior for a problem behavior, such as taking a walk whenever feeling stressed, can be effective.

“In making the transition from group to being on your own, committing yourself by developing  an activity schedule and identifying activities that are enjoyable, even signing a 'contract' with a social support partner would be useful,” Cardinal said.

Also, having a network of friends, family or providers who provide encouragement and support is also a factor that helps people to stick with exercise.

“Rewarding yourself for small successes and gradually building on that is also important,” he said. “It is critical to not expect too much too soon. And fitness instructors and future exercise scientists can help by preparing them before the last day of class on what to expect when they go from that group exercise environment to an individual setting.”

In addition, Cardinal said he would like to see policy makers address the issue of support for cancer survivors.

“We know survivors of breast cancer are much more likely to stick with exercise if they have that structured, group support,” Cardinal said. “Ideally, it would be great if insurance programs provided for that post-treatment supervised exercise longer than one year. But in lieu of that, we can help them build the skills to continue on their own successfully.”

The exercise study which provided data for Loprinzi’s publication was funded by the National Institutes of Health by a grant to the study’s co-author, Kerri Winters-Stone of OHSU.

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Bradley Cardinal, 541-737-2506

Study finds improved communication could reduce STDs among black teens

CORVALLIS, Ore. – Black urban teenagers from low-income families face a rate of sexually transmitted disease up to 10 times higher than their white counterparts, but recent studies at Oregon State University have identified approaches to prevention programs that might reduce this problem.

The research, based on interviews of black adolescents ages 15-17 in San Francisco and Chicago, found that information from parents, teachers and other caring adults is actually listened to, more than the adults might think. And the problem of youth getting “mixed messages” from different entities, ranging from schools to movies, churches, peer groups and medical clinics, may not be that large of an issue.

If teenagers get a wide range of medical, social, educational and personal support and information from multiple sources, they are fairly adept at separating the good sense from the nonsense, scientists said. Unfortunately, that broad range of information and communication often doesn’t exist.

And somewhat surprisingly, the research found that few youth use or trust the Internet for information on sexual health.

“The level of sexual activity at a young age and incidence of STDs, including HIV and AIDS, in low-income, urban black teenagers is high,” said Margaret Dolcini, an associate professor in OSU's College of Public Health and Human Sciences. “We have made strides in prevention, but need to continue to deepen our understanding of the factors that contribute to unsafe sexual activity.’

The OSU studies were published in Research in Human Development, a scientific journal, with support from the National Institutes of Health. They explored the influences and pressures this group of teenagers faced, including choices to have sex, where people get information, and how that affects behavior.

“We found that young black kids who got information from varied sources tended to do pretty well in making smart choices,” Dolcini said.

The most important progress, the OSU researchers found, could be made if various educational, religious and social support organizations would make a more concerted effort to address issues collectively, within the constraints of their roles and belief systems.

“We need more collaboration between family, schools, medical clinics, churches, and other entities that traditionally may not have worked together,” Dolcini said.

“This is possible, and we should encourage more of it,” she said. “We wouldn’t necessarily expect a church to offer condom demonstrations, but a community clinic or school sex education program might do exactly that. And there’s a place for both.”

Among the findings of the studies:

  • Stressing abstinence at young ages is appropriate, but could be made far more effective if youth were taught other forms of emotional interaction as an alternative to sexual intercourse.
  • Sex education will be more effective if sex is treated as a healthy part of life at appropriate ages and circumstances.
  • Young women benefitted strongly from families who had open lines of communication, talked about sex, monitored their activities and made it clear their health and safety was important.
  • Many teenagers have received surprisingly little accurate information about sex and sexual health.
  • Sex education programs in schools are nearly universal and there is also strong participation in sex-related education from youth at community centers.

This research was outlined this year in several publications by Peggy Dolcini and Joseph Catania at OSU, as part of their work with the Hallie E. Ford Center for Healthy Children and Families. It was done in collaboration with researchers from the University of California-San Francisco, University of Alberta, DePaul University, Michigan State University and other organizations.

 

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M. Margaret Dolcini, 541-737-3829

Statewide public health conference set for Oct. 8-9

CORVALLIS, Ore. – Topics ranging from water fluoridation to prenatal care issues to the Oregon Health Plan will be discussed at the Oregon Public Health Association Conference Oct. 8-9 at Oregon State University’s LaSells Stewart Center.

Two keynote speakers will be featured at this year's conference. Richard Jackson, M.D., is professor at the University of California at Los Angeles and host of the PBS series, “Designing Healthy Communities.” In the past decade, much of his work has focused on how the "built environment" affects health. Jackson speaks at 9:30 a.m. Monday, Oct. 8.

Bruce Goldberg, M.D., is a family physician who is helping to lead Oregon's health care transformation as director of the Oregon Health Authority. Goldberg will speak at 9 a.m. Tuesday, Oct. 9.

“So often conversations about health focus on providing medical care to individuals,” Goldberg said. “But if people leave their doctor's office and go back to their community where nutritious food is not available, there are no sidewalks for walking, and the air is polluted, their health will suffer.”

In addition to the keynote talks, more than 80 presentations on key functional areas of public health and discussion forums will be held. Sessions will cover a wide variety of topics, including tobacco cessation and policies, a case study of Portland’s water fluoridation controversy, alcohol abuse prevention, obesity, prenatal care, contraception, and reduction of health disparities. A full schedule is at: http://www.oregonpublichealth.org/2012-conference

“This year, attention to community and built environments, as well as their impact on the long-term success of Oregon’s health services reform, make the conference an especially important networking opportunity for rural and urban stakeholders, elected officials, planners and public health professionals,” said Tom Eversole, president-elect of the Oregon Public Health Association and director of strategic development at OSU’s College of Public Health and Human Sciences.

The conference is open to the public with a fee. News media are welcome to attend and can contact Angela Yeager or Marie Harvey.

The conference is sponsored by Conference of Local Health Officials, NorthWest Health Foundation, Oregon Health & Science University, and the OSU College of Public Health and Human Sciences.

Follow the conference and annual meeting on Twitter @ORPublicHealth and the conference hashtag at #OPHA12.

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Marie Harvey, 541-737-3824

Family harvest party and garden tour held Sept. 30

CORVALLIS, Ore. – A second annual harvest party with music, cider pressing, garden tours and kids’ activities will be held Sunday, Sept. 30, in Corvallis.

The free event will run from 11:30 a.m. to 2 p.m. in the WORMS Youth Garden at Westside Community Church, 4000 S.W. Western Blvd. The public is invited to tour this community garden, where there will be produce for sale, a raffle for prizes, and many activities for children including a scavenger hunt and face painting.

This event is an opportunity to tour a 10,000-square-foot youth garden that resulted out of an Oregon State University project.

The project, “Producing for the Future: A Collaboration between Low-Income Youth, Congregations, and Researchers,”  is funded by the National Institutes of Health and is designed to explore the health benefits of community-based garden programs. It brings together low-income youth ages 16-25, members of local faith-based communities, and university researchers to provide training, work experience, and improved health outcomes.

Youth, adult partners, and OSU researchers have worked together since early 2011 to design and plant a community garden and develop a microenterprise venture to market the produce grown. Using a process known as Community Based Participatory Research, youth, adult partners, and OSU researchers are collecting and analyzing data evaluating the project, and providing training and outreach to other communities interested in similar collaborations. Individuals in the project are both project designers and research participants.

Leslie Richards, assistant professor of human development and family sciences, is leading the research project. She said it is designed to teach young people entrepreneurship skills, as well as partner youth with adults to address issues of social injustice.

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Preschool children who can pay attention more likely to finish college

CORVALLIS, Ore. – Young children who are able to pay attention and persist with a task have a 50 percent greater chance of completing college, according to a new study at Oregon State University.

Tracking a group of 430 preschool-age children, the study gives compelling evidence that social and behavioral skills, such as paying attention, following directions and completing a task may be even more crucial than academic abilities.

And the good news for parents and educators, the researchers said, is that attention and persistence skills are malleable and can be taught.

The results were just published online in Early Childhood Research Quarterly.

“There is a big push now to teach children early academic skills at the preschool level,” said Megan McClelland, an OSU early child development researcher and lead author of the study. “Our study shows that the biggest predictor of college completion wasn’t math or reading skills, but whether or not they were able to pay attention and finish tasks at age 4.”

Parents of preschool children were asked to rate their children on items such as “plays with a single toy for long periods of time” or “child gives up easily when difficulties are encountered.” Reading and math skills were assessed at age 7 using standardized assessments. At age 21, the same group was tested again for reading and math skills.

Surprisingly, achievement in reading and math did not significantly predict whether or not the students completed college. Instead, researchers found that children who were rated higher by their parents on attention span and persistence at age 4 had nearly 50 percent greater odds of getting a bachelor’s degree by age 25.

McClelland, who is a nationally-recognized expert in child development, said college completion has been shown in numerous studies to lead to higher wages and better job stability. She said the earlier that educators and parents can intervene, the more likely a child can succeed academically.

“We didn’t look at how well they did in college or at grade point average,” McClelland said. “The important factor was being able to focus and persist. Someone can be brilliant, but that doesn’t necessarily mean they can focus when they need to and finish a task or job.”

McClelland, who is also a core director in OSU’s Hallie E. Ford Center for Healthy Children and Families, said interventions aimed at increasing young children’s self-control abilities have repeatedly shown to help boost “self-regulation,” or a child’s ability to listen, pay attention, follow through on a task and remember instructions.

In a past study, McClelland found that simple, active classroom games such as Simon Says and Red Light/Green Light have been effective tools for increasing both literacy and self-regulation skills.

“Academic ability carries you a long way, but these other skills are also important,” McClelland said. “Increasingly, we see that the ability to listen, pay attention, and complete important tasks is crucial for success later in life.”

OSU’s Alan Acock, along with Andrea Piccinin of the University of Victoria and Sally Ann Rhea and Michael Stallings of the University of Colorado, contributed to this study, which was funded by the National Institute of Child Health and Human Development and a Colorado Adoption Project grant.

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Megan McClelland, 541-737-9225

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Megan McClelland

Community garden open house held Aug. 9 in Sweet Home

SWEET HOME, Ore. – An open house to celebrate the achievement of local youth to create a thriving organic garden will be held Thursday, Aug. 9, in Sweet Home.

The event will be from 4 to 6 p.m. at the Sweet Home United Methodist Church, 845 6th Ave. It is free and open to the public.

As part of Oregon State University’s “Producing for the Future” research project, 14 low-income people ages 16-22 have been tending a local community garden and selling the produce at the Sweet Home Farmers’ Market on Saturdays, and at a Sunday booth at the Methodist Church. This open house celebrates and honors their work.

Fun activities for all ages will be available at the event, including garden tours, face painting, veggie games, recipe samples, a kids’ coloring table, a potato dig, and more.

Producing for the Future is funded by the National Institutes of Health and is a collaboration between low-income youth, community congregations, and researchers from OSU’s College of Public Health and Human Sciences.

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Liv Gifford, 541-737-3668

Lower vitamin D could increase risk of dying, especially for frail, older adults

CORVALLIS, Ore. – A new study concludes that among older adults – especially those who are frail – low levels of vitamin D can mean a much greater risk of death.

The randomized, nationally representative study found that older adults with low vitamin D levels had a 30 percent greater risk of death than people who had higher levels.

Overall, people who were frail had more than double the risk of death than those who were not frail. Frail adults with low levels of vitamin D tripled their risk of death over people who were not frail and who had higher levels of vitamin D.

“What this really means is that it is important to assess vitamin D levels in older adults, and especially among people who are frail,” said lead author Ellen Smit of Oregon State University.

Smit said past studies have separately associated frailty and low vitamin D with a greater mortality risk, but this is the first to look at the combined effect. This study, published online in the European Journal of Clinical Nutrition, examined more than 4,300 adults older than 60 using data from the Third National Health and Nutrition Examination Survey.

“Older adults need to be screened for vitamin D,” said Smit, who is a nutritional epidemiologist at OSU’s College of Public Health and Human Sciences. Her research is focused on diet, metabolism, and physical activity in relation to both chronic disease and HIV infection.

“As you age, there is an increased risk of melanoma, but older adults should try and get more activity in the sunshine,” she said. “Our study suggests that there is an opportunity for intervention with those who are in the pre-frail group, but could live longer, more independent lives if they get proper nutrition and exercise.”

Frailty is when a person experiences a decrease in physical functioning characterized by at least three of the following five criteria: muscle weakness, slow walking, exhaustion, low physical activity, and unintentional weight loss. People are considered “pre-frail” when they have one or two of the five criteria.

Because of the cross-sectional nature of the survey, researchers could not determine if low vitamin D contributed to frailty, or whether frail people became vitamin D deficient because of health problems. However, Smit said the longitudinal analysis on death showed it may not matter which came first.

“If you have both, it may not really matter which came first because you are worse off and at greater risk of dying than other older people who are frail and who don’t have low vitamin D,” she said. “This is an important finding because we already know there is a biological basis for this. Vitamin D impacts muscle function and bones, so it makes sense that it plays a big role in frailty.”

The study divided people into four groups. The low group had levels less than 50 nanomole per liter; the highest group had vitamin D of 84 or higher. In general, those who had lower vitamin D levels were more likely to be frail.

About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D. And during the winter months in northern climates, it can be difficult to get enough just from the sun. OSU’s Linus Pauling Institute recommends adults take 2,000 IU of supplemental vitamin D daily. The current federal guidelines are 600 IU for most adults, and 800 for those older than 70.

“We want the older population to be able to live as independent for as long as possible, and those who are frail have a number of health problems as they age,” Smit said. “A balanced diet including good sources of vitamin D like milk and fish, and being physically active outdoors, will go a long way in helping older adults to stay independent and healthy for longer.”

Researchers from Portland State University, Drexel University of Philadelphia, University of Puerto Rico and McGill University in Montreal contributed to this study. It was funded in part by the National Institutes of Health and a grant from OSU.

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Ellen Smit, 541-737-3833

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Milk is one of the sources of vitamin D. About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D.

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Milk is one of the sources of vitamin D. About 70 percent of Americans, and up to a billion people worldwide, have insufficient levels of vitamin D.

Physical health problems increase use of mental health services

CORVALLIS, Ore. – People who experience a physical health problem, from diabetes and back pain to cancer or heart disease, are three times more likely to seek mental health care than patients who report having no physical ailment, according to a new study by Oregon State University researchers.

The study, which is now online in the journal Health Services Research, indicates there is a need for better-coordinated care between physical and mental health providers. It is the first nationally representative study that statistically shows a major link between physical health and mental health

“I see this study as a way to set benchmark data so that policy makers can determine how to best transition to a system that hopefully will coordinate physical and mental care,” said lead author Jangho Yoon, a health policy economist with OSU who specializes in mental health policy issues.

“The Affordable Care Act is supposed to have better coordinated care and interplay between physical and mental health providers, so this has really important implications because before our study, baseline data didn’t exist.”

Yoon used data from 2004 and 2005 Medical Expenditure Panel Surveys to identify more than 6,000 adults for his study. He only used people who had not reported a previous physical or mental health condition. Compared to those who did not have a physical health problem, people who developed a physical health condition had a threefold increase in the likelihood of seeking mental health care.

Interestingly, even after he controlled for those who developed the most catastrophic medical conditions, such as cancer, stroke and heart attack, he found the same results.

“The interplay between our physical and mental health has long been suspected,” Yoon said. “When I have back pain, I feel stressed. And if it impacts my ability to work, or to do my usual activities, then I can feel upset or even a bit depressed. But no large scale studies existed that showed the statistical proof of this correlation.”

Yoon, who is an assistant professor in the College of Public Health and Human Sciences at OSU, said the study included people who sought mental health providers, prescriptions for mental health issues, or both.

He said the study also found that those patients who said they perceived their health issue as severe were more likely to seek mental health services.

The researchers said a simple screener survey, such as the 16-question Substance Abuse/Mental Illness Screener (SAMISS), used in a busy clinical setting could be an effective tool to help health providers attain proper mental health treatment for their patients.

“This is a win-win,” Yoon said. “There is a chance of cost-savings in our medical system if we identify potential mental health problems early, before they become more severe. And more importantly, coordinated care and early intervention leads to better health outcomes, and better care for the patient.”

Stephanie Bernell of OSU’s health management and policy program, contributed to the study.

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Frail, older adults with high blood pressure may have lower risk of mortality

CORVALLIS, Ore. – A new study suggests that higher blood pressure is associated with lower mortality in extremely frail, elderly adults.

The study, published today in the Journal of the American Medical Association’s (JAMA) Archives of Internal Medicine, looked at a nationally representative group of 2,340 adults ages 65 and older. The researchers found that lower blood pressure protected healthier, robust older adults but the same may not be true for their more frail counterparts.

Lead author Michelle Odden, a public health epidemiologist at Oregon State University, said blood pressure rises naturally as people age. Her study used walking speed as a measure of frailty. Participants were asked to walk a distance of about 20 feet at their normal rate. Those who walked less than 0.8 meters per second were defined as slower walkers. Those who walked faster than 0.8 meters per second were in the second group of more robust adults, who also had a lower prevalence of diabetes, coronary heart disease, stroke and heart failure.

The third group included those who were not able to complete the walking test for various reasons, including inability to walk 20 feet.

“As we age, our blood vessels lose elasticity and becomes stiff,” Odden said. “Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.”

Odden said the mortality differences between the fast walkers and slow walkers or non-completers can be explained simply – everyone ages differently.

“There is a profound difference in the physiological age of an 80-year-old man who golfs every day, and someone who needs a walker to get around,” she said. “So in the fast walkers, high blood pressure may be more indicative of underlying disease, not just a symptom of the aging process.”

Among the faster walkers, those with high blood pressure had a 35 percent greater risk of dying compared with those with normal blood pressure.

In contrast, there was no association between high blood pressure and mortality in the slow walking group. Strikingly, those who were unable to complete the walking test had the opposite results – those with higher blood pressure had a 62 percent lower mortality rate.

Since this is one of the first studies to examine walking speed, mortality and blood pressure, Odden cautioned against people making health decisions based on these early findings.

“Any sort of decision regarding medication use should be done in consultation with a physician,” she said. “Our study supports treating high blood pressure in healthy, active older adults. But in frail older adults, with multiple chronic health conditions, we need to take a closer look at what sorts of effects high blood pressure could serve and whether having a higher blood pressure could be protective.”

Odden is an expert on chronic disease and disease prevention in aging populations, particularly in regard to cardiovascular health and kidney disease. Her work is funded by the National Institute on Aging and the American Heart Association Western States Affiliate.

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Michelle Odden, 541-737-3184

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OSU Pharm.D. student takes a blood pressure reading at a screening. Photo: courtesy of Oregon State University.

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This chart designed by OSU College of Public Health and Human Sciences researcher Michelle Odden shows the link between elevated blood pressure, walking speed, and mortality. Courtesy of Michelle Odden/Oregon State University.

Moderate alcohol consumption may help prevent bone loss

CORVALLIS, Ore. – Drinking a moderate amount of alcohol as part of a healthy lifestyle may benefit women’s bone health, lowering their risk of developing osteoporosis.

A new study assessed the effects of alcohol withdrawal on bone turnover in postmenopausal women who drank one or two drinks per day several times a week. Researchers at Oregon State University measured a significant increase in blood markers of bone turnover in women after they stopped drinking for just two weeks.

Bones are in a constant state of remodeling with old bone being removed and replaced. In people with osteoporosis, more bone is lost than reformed resulting in porous, weak bones. About 80 percent of all people with osteoporosis are women, and postmenopausal women face an even greater risk because estrogen, a hormone that helps keep bone remodeling in balance, decreases after menopause.

Past studies have shown that moderate drinkers have a higher bone density than non-drinkers or heavy drinkers, but these studies have provided no explanation for the differences in bone density. Alcohol appears to behave similarly to estrogen in that it reduces bone turnover, the researchers said.

In the current study, published online today in the journal Menopause, researchers in OSU’s Skeletal Biology Laboratory studied 40 early postmenopausal women who regularly had one or two drinks a day, were not on any hormone replacement therapies, and had no history of osteoporosis-related fractures.

The researchers found evidence for increased bone turnover – a risk factor for osteoporotic fractures – during the two week period when the participants stopped drinking. Even more surprising: the researchers found that less than a day after the women resumed their normal drinking, their bone turnover rates returned to previous levels.

“Drinking moderately as part of a healthy lifestyle that includes a good diet and exercise may be beneficial for bone health, especially in postmenopausal women,” said Urszula Iwaniec, associate professor in the College of Public Health and Human Sciences at OSU and one of the study’s authors. “After less than 24 hours to see such a measurable effect was really unexpected.”

Iwaniec, OSU’s Skeletal Biology Laboratory director Russell Turner, and researcher Gianni Maddalozzo assisted OSU alumna Jill Marrone with the study, which was Marrone’s master’s thesis.

This study is important because it suggests a cellular mechanism for the increased bone density often observed in postmenopausal women who are moderate drinkers, Turner said.

The researchers said many of the medications to help prevent bone loss are not only expensive, but can have unwanted side effects. While excessive drinking has a negative impact on health, drinking a glass of wine or beer regularly as part of a healthy lifestyle may be helpful for postmenopausal women.

“Everyone loses bone as they age, but not everyone develops osteoporosis,” Turner said. “Being able to identify factors, such as moderate alcohol intake, that influence bone health will help people make informed lifestyle choices.”

The study was funded by grants from the National Institutes of Health and the John C. Erkkila, M.D. Endowment for Health and Human Performance.

Karin Hardin, Adam Branscum, Kenneth Philbrick and Lynn Cialdella-Kam of OSU co-authored the study, along with Anne Breggia and Clifford Rosen of the Maine Medical Center Research Institute.

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Urszula Iwaniec, 541-737-9925

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Urszula Iwaniec, associate professor in the College of Public Health and Human Sciences at OSU, pictured here with student Bailey Lindenmaier in the OSU Skeletal Biology Laboratory on campus.