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Objective: The purpose is to describe the development and validation of a tool to measure the degree of past food insecurity in an immigrant US population. Design: Focus group discussions and a structured interview. As a first step, focus group discussions were conducted among immigrant Latino mothers. Based on these discussions, an 8-item tool was developed and pilot-tested in a convenience sample of mothers. Selling: California. Participants: Twenty-two low-income Latino mothers with children, ages 4 to 5 years, in the focus groups and 85 low-income Latino and white mothers of young children in the structured interviews. Analyses: Constant comparative analysis, Cronbach [alpha], Spearman correlations, Chi-square, and Kruskal-Wallis test. Results: Internal consistency of the remaining 7 items was good (Cronbach [alpha], = 0.84). Evidence of convergent validity included significant correlations between past food insecurity and maternal education (r = -0.45, p Conclusions and Implications: This tool may be useful to determine how past deprivation influences current food choices and other nutrition-related behaviors in low-income Latino immigrants. Key Words: Latino, food insecurity, life course perspective

Objective: Examine effectiveness of a state's Youth Expanded Food and Nutrition Education Program (EFNEP) and assess the validity of the federal impact indicator method for reporting program outcomes. Design: A randomized, controlled field trial of 229 groups with 5,111 youth, 9-12 years old, in community settings. Intervention: 6- to 8- hour, 7-lesson education experience with food preparation and tasting, an education experience typical of EFNEP in California. Outcome Measures: US Department of Agriculture (USDA) impact indicators: nutrition knowledge, eating a variety of foods, food selection, and food preparation and safety practices. Analysis: Analysis of covariance model controlling for pretest, gender, age, and ethnicity, with group nested in condition. Results: Organizing responses by impact indicators, treatment participants made significant gains on the posttest compared to controls for 3 of 4 indicators (P < .008 to P < .0001). Gains were made by 34 to 68% of youth participants for 4 indicators. The impact indicator method for federal reporting compared favorably with results from a randomized controlled trial with groups nested in conditions. Conclusion and Implications: This is the first report in the literature of (1) a large evaluation study of Youth EFNEP and (2) an estimate of the validity of the USDA impact indicator method for reporting program outcomes. Key Words: EFNEP, evaluation, youth, children, impact indicator, USDA

The purpose of this paper is to describe a process for developing and validating outcome measures relevant to dietary quality behaviors targeted by Food Stamp Nutrition Education (FSNE). The ultimate goal is a measure that is valid, reliable, sensitive to change, and practical for use for a wide variety of FSNE evaluation purposes. The development process has incorporated input from FSNE stakeholders at the federal and state level and follows a systematic, research-driven approach that incorporates both qualitative and quantitative research and includes methods for identification of subject domains, selection of evaluation items, initial pretesting, and reduction of items. This type of research establishes the trustworthiness of new evaluation measures. Key Words: evaluation, measure, validity, reliability, FSNE

Objective: Development of an evaluation tool of psychosocial constructs for use by participants in 2 federal programs, Food Stamp Nutrition Education and the Expanded Food and Nutrition Education Program. Design: Cross-sectional data from a longitudinal study. Participants: Limited-resource women (n = 111) living in low-income communities. Measures: Test-retest reliability, internal consistency, ethnic differences, convergent validity. Analysis: Spearman rank order correlation, analysis of variance, principal components analysis. Results: Reliability coefficients ranged from a low of r = .18 (not significant) to r = .74 (P < .0001). Two items were deleted for not meeting criteria for reliability and 2 for redundancy. Ethnic differences at baseline were significant for 1 item. Domain constructs loaded on 4 to 5 factors for the biopsychosocial framework. Estimates of convergent validity of 9 constructs led to the deletion of 3 (ie, perceived barriers, social support, and perceived norms), with retention of perceived benefits, perceived control, self-efficacy, readiness to eat more fruit, readiness to eat more vegetables, and perceived diet quality. As an estimate of convergent validity, the final version of the tool with 6 constructs remaining showed significant correlations with indicators of diet quality: serum carotenoid values (r = .38, P < .001); hypothesized nutrients calculated from the mean of 3 24-hour dietary recalls (vitamin C, r = .47, P < .0001; vitamin A, r = .39, P < .0001; folate, r = .37, P < .0001; betacarotene, r =.31, P < .001; and fiber, r = .46, P < .0001); fruit and vegetable servings (r = 0.55, P < .0001); Healthy Eating Index (r = .27, P < .05); and a fruit and vegetable behavioral scale (r = .60, P < .0001). Conclusion and Implications: This systematic process yielded a fruit and vegetable evaluation tool useful for practitioners and researchers. This is the first validation study of this type to estimate convergent validity with 5 indicators of diet quality, including a biomarker. KEY WORDS: evaluation, health beliefs, Expanded Food and Nutrition Education Program (EFNEP), Food Stamp Nutrition Education (FSNE), low income, fruits, vegetables, Healthy Eating Index

Objective: To describe depictions of food, alcohol, and exercise and sport in popular films. Design: Content analysis of the 10 top-grossing films each year from 1991 to 2000 (N = 100 films). Analysis: Coding reliabilities were assessed with Cohen's [kappa]. Research questions were addressed with basic descriptive statistics. Associations among variables were examined through a cross-tabulation procedure that corrects for the clustering of exercise and food depictions within movies. Results: Food and drink appeared regularly in the films analyzed, typically as a background element or prop. On average, food appeared on the screen once every 4.2 minutes. The foods shown were most likely to be fats, oils, and sweets; fruits, vegetables, and dairy products were rarely seen. More than 20% of the food items shown were alcoholic beverages, which were nearly 2 times more likely to be ingested as nonalcohol food items. Planned exercise and sports appeared at a rate of about 2 incidents per hour. These activities rarely received explicit evaluation by characters. Conclusions and Implication: Films frequently portray foods and exercise. These depictions have the potential to cultivate beliefs about normative eating and exercise behavior, suggesting a need for public health professionals to encourage the media to offer healthier images. KEY WORDS: movies, film, food, exercise

Objective: To examine the relationship between food insecurity and food supplies in Latino households. Design: Cross-sectional survey, conducted February to May 2001. Setting: Six California counties. Participants: Convenience sampling was used to recruit 274 low-income Latino families with preschool children from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Head Start, and other community-based organizations. Complete data were available for 256 families. Variables Measured: Food security, household food scores. Analysis: Pearson correlations, Kruskal-Wallis test, and logistics regression. Significance level at P < .05. Results: Controlling for maternal education, food insecurity over the past 3 months was associated with lower household food supplies: dairy, r = -.18, P < .01; fruit, r = -.36, P < .001; grains, r = -.27, P < .0001; meats, r = -.22, P < .001; snack foods, r = -.23, P < .001; and vegetables, r = -.29, P < .001. Conclusions and Implications: In Latino households, greater food insecurity is associated with a lower variety of most foods, particularly fruits and vegetables. Future research in Latino households should explore the effects of seasonal food insecurity and household food shortages on food intake of individual household members, especially young children. KEY WORDS: food insecurity, Latinos, household food supplies

Objective: To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. Design: Random assignment to the intervention and control groups. Setting: Low-income communities. Participants: Women (N = 132) from limited-resource families. Main Outcome Measures: Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. Results: The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r = .44, P < .001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. Conclusions and Implications: This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions. KEY WORDS: evaluation, food behaviors, Expanded Food and Nutrition Education Program (EFNEP), low income

Many clients in low-income community education programs have literacy problems, thereby making a text-only evaluation instrument difficult to use. There is a need for visually enhanced evaluation tools. Using a 16-item food behavior checklist (FBC) previously shown to be reliable, valid, and sensitive to change, we tested a series of formats and visuals (photographs and line drawings) to determine the best evaluation instrument for Food Stamp clients. A systematic process consisting of 3 levels of review was developed for the comparison of potential formats and visuals. Level I: research and academic program professionals. Level II: community-based paraprofessionals in the Food Stamp and the Expanded Food and Nutrition Education Programs. Level III: Food Stamp clients. Using cognitive interviewing procedures, Food Stamp clients described their preferences for the visuals. Clients were asked how the proposed visuals could be made to be more understandable to their peers. Generally, level I and II reviews resulted in more complex visuals for each of the 16 FBC items than the previous versions; however, the cognitive testing of Food Stamp clients revealed the need for less detail in the visuals. This systematic process produced an evaluation tool containing 16 visually enhanced items in a 4-page color booklet in which the items are easier to understand than the text-only version. Funding provided by the California Public Health Institute, the Expanded Food and Nutrition Education Program, and the University of California Cooperative Extension.

Objective: To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California. Design: Data from the 2005 California Women's Health Survey (CWHS) - a crosssectional telephonic survey of health indicators and health-related behaviours and attitudes - were used. Setting: Using a random-digit dialling process, data were collected monthly from January to December 2005. Subjects: A total of 1298 women aged ≥18 years in California who self-identified as Hispanic. Results: Of the participants included in the analysis, 49% were adherent to physical activity recommendations (with 150min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P=0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P=0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model. Conclusions: Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population. [ABSTRACT FROM AUTHOR]

Analysis of the first National Health and Nutrition Examination Survey (NHANES) in 1984 revealed that a dietary pattern low in mineral intake, specifically calcium, potassium, and magnesium, was associated with hypertension in American adults. Using more recent survey data from NHANES III and NHANES IV, we re-examined the validity of this relationship. Blood pressure (BP) and nutrient intake data from 10,033 adult participants in NHANES III and 2311 adults in NHANES IV revealed findings similar to those of the earlier analysis, demonstrating that the association between inadequate mineral consumption and higher BP is valid and has persisted over two decades. Exploring this relationship further, we separated untreated hypertensive persons by hypertension type (systolic, diastolic, or both), and observed that the BP effect of low mineral intake was most pronounced in those with only systolic hypertension. We also observed that sodium intake was significantly lower in the systolic hypertension group and significantly higher in the diastolic hypertension group compared with the other groups. The nutrient pattern in the combined hypertension group was similar to that of the normotensive group. These findings may help to explain the inconsistent responses generally observed in dietary intervention studies, and they highlight the possible importance of tailored nutritional recommendations for hypertension based on hypertension category and individual dietary practices. Although randomized controlled trials are needed to characterize further the relationship between nutrient intake and hypertension type, these findings indicate that dietary management of hypertension may be more effective if the focus is on the overall nutritional profile rather than single-nutrient intake as currently recommended for most patients. [Copyright &y& Elsevier]

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI >27.3 kg/m(2) for women and 27.8 kg/m(2) for men. Food insecurity was related to overweight status for women (n = 4509, P < 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P < 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective. Estimate effectiveness of goal setting for nutrition and physical activity behavior change, review the effect of goal-setting characteristics on behavior change, and investigate effectiveness of interventions containing goal setting. Data source. For this review, a literature search was conducted for the period January 1977 through December 2003 that included a Current Contents, Biosis Previews, Medline, PubMed, PsycINFO, and ERIC search of databases and a reference list search. Key words were goal, goal setting, nutrition, diet, dietary, physical activity, exercise, behavior change, interventions, and fitness. Study inclusion and exclusion criteria. The search identified 144 studies, of which 28 met inclusion criteria for being published in a peer reviewed journal and using goal setting in an intervention to modify dietary or physical activity behaviors. Excluded from this review were those studies that (1) evaluated goal setting cross-sectionally without an intervention; (2) used goal setting for behavioral disorders, to improve academic achievement, or in sports performance, (3) were reviews. Data extraction and synthesis. The articles were categorized by target audience and secondarily by research focus. Data extracted included outcome measure, research rating, purpose, sample, sample description, assignment, findings, and goal-setting support. Results. Thirteen of the 23 adult studies used a goal-setting effectiveness study design and eight produced positive results supporting goal setting. No adolescent or child studies used this design. The results were inconclusive for the studies investigating goal-setting characteristics (n = 7). Four adult and four child intervention evaluation studies showed positive outcomes. No studies reported power calculations, and only 32% of the studies were rated as fully supporting goal setting. conclusions. Goal setting has shown some promise in promoting dietary and physical activity behavior change among adults, but methodological issues still need to be resolved. The literature with adolescents and children is limited, and the authors are not aware of any published studies with this audience investigating the independent effect of goal setting on dietary or physical activity behavior Although, goal setting is widely used with children and adolescents in nutrition interventions, its effectiveness has yet to be reported. [ABSTRACT FROM AUTHOR]