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Objectives Pediatric obesity is complicated by many factors including psychological issues, such as body dissatisfaction. Body image assessment tools are used with children to measure their acceptance of their body shape or image. Limited research has been conducted with African American and American Indian children to understand their opinions on assessment tools created. This study investigated: (a) children's perception about body image and (b) differences between two body image instruments among low-income, multi-ethnic children. Methods This study uses mixed methodology including focus groups (qualitative) and body image assessment instruments (quantitative). Fifty-one children participated (25 girls, 26 boys); 53% of children identified as African American and 47% as American Indian. The average age was 10.4 years. Open coding methods were used by identify themes from focus group data. SPSS was used for quantitative analysis. Results Children preferred the Figure Rating Scale (FRS/silhouette) instrument over the Children's Body Image Scale (CBIS/photo) because their body parts and facial features were more detailed. Children formed their body image perception with influence from their parents and the media. Children verbalized that they have experienced negative consequences related to poor body image including disordered eating habits, depression, and bullying. Healthy weight children are also aware of weight-related bullying that obese and overweight children face. Conclusions for Practice Children prefer that the images on a body image assessment tool have detailed facial features and are clothed. Further research into body image assessment tools for use with African American and American Indian children is needed.

This study evaluated the appropriateness of the Kid's Block Food Frequency Questionnaire (Kid's Block FFQ) for use in a group of urban Native American youth by comparing it to a self-reported 24-hr recall. Subjects were 61 urban Native American youth, aged 9-13 years. Researchers assessed dietary intake using the two methods in random order on the same day. Analyses of diets revealed no significant difference between estimated total energy, protein, fat, and saturated fat between the two methods. Significant differences in estimations for the two tools occurred for carbohydrates and some micronutrients. Results suggest that the Kid's Block FFQ may be less appropriate than 24-hr recall in measuring the dietary intake of Native American youth. A high prevalence of obesity in this population necessitates more accurate dietary assessment tools for this population.

Objective: To determine inner city American Indians' perceptions of diabetes; find out how they manage their disease; and identify what health care improvements may be necessary for this population., Design: Eight focus group discussions conducted with diabetic inner city American Indian adults., Setting: Focus group discussions led by moderator using open-ended questions with prompts., Participants: Eligibility criteria include age (> or = 18 years), a self-reported diagnosis of diabetes, and self-identification as inner city American Indian. Participants were screened by telephone to ensure all criteria were met. Forty inner city American Indian men and women participated in 8 focus groups., Phenomenon of Interest: American Indians' perception of diabetes, its treatment, and how they manage the disease., Analysis: Focus group discussions were tape recorded and transcribed verbatim. Transcripts were analyzed by coding responses and identifying common themes according to content analysis procedures. Quantitative data from self-administered demographic forms were analyzed., Results: Participants could verbalize information regarding treatment and management of diabetes, but few could apply this information to their own lives. Some participants were homeless or without insurance, which makes successful disease management difficult. Perceptions of the health care system varied; a majority felt the system was meeting their needs, whereas others said it was not adequate., Implications for Research and Practice: The study identified the need for health care workers to develop a better understanding of how this population lives; doing so could improve patient compliance to treatment. The results may provide direction for the development of culturally specific diabetes education appropriate for low-income patients focusing on the diabetic diet and exercise, and suggesting ways that the patient can move from knowing the information to implementing behavior change.

Objective: The goals of this study were to explore the perceptions of professionals concerning research, its different approaches, and appropriate future directions with Native American communities, particularly in relation to nutrition issues., Design: Semistructured qualitative interviews. setting: Interviews were conducted at Native and non-Native academic institutions, at other relevant locations, and over the telephone., Participants: Participants (N = 20) were from Native and non-Native academic institutions and had experience working with research in Native American communities., Phenomena of Interest: Relationships between Native and non-Native academic institutions, worldviews regarding research and American Indian communities, and beneficial research within American Indian communities., Analysis: Interviews were audiotaped, transcribed verbatim, and returned to the participants for review. Analysis of interview material involved eliciting themes., Results: Some participants acknowledged different cultural worldviews in relation to research. Many participants provided insight on how to define beneficial research. Most said building trust between Native and non-Native academic institutions is an important step in developing effective research relationships., Conclusions and Implications: These findings are a first step toward creating a more equitable process of research that acknowledges different cultural worldviews and values community involvement within Native American communities.

Objective: To improve dietary self-efficacy through a 7-month nutrition intervention for Native American children (5 to 10 years) and adolescents (11 to 18 years)., Design: Single-group pretest, posttest design., Setting: An after-school program in a local community center for urban Native American youth., Participants: 104 urban Native American youth (65 children and 39 adolescents)., Intervention(s): A 9-month project with pre-post evaluation and a 7-month intervention., Main Outcomes Measure(s): Dietary self-efficacy and 24-hour recalls., Analysis: Descriptive statistics were computed for comparability analysis of dietary self-efficacy and diet at baseline. For the normally distributed data, independent t tests were used for gender comparisons, whereas 1-way analysis of variance with post hoc Tukey adjustment was used to compare responses among body mass index (BMI) categories. Non-normally distributed data were analyzed with Kruskal-Wallis tests with post hoc pairwise Mann-Whitney analyses. For non-normally distributed data, the Bonferroni correction was used, and the P values were set at .025 for gender comparisons and .016 for BMI comparisons. Wilcoxon signed rank tests determined whether fat and sugar intake changed significantly between pre- and postintervention time points among adolescents., Results: Both children and adolescents exhibited moderate levels of dietary self-efficacy at baseline, with no variation by BMI. The nutrition intervention significantly improved the self-efficacy of children. Overweight children significantly improved their dietary self-efficacy. The intervention was not successful among adolescents., Conclusions and Implications: Social Cognitive Theory is an effective model from which to explore influential constructs of health behavior. This project demonstrates that a nutrition intervention provided at monthly intervals is an effective way to significantly improve dietary self-efficacy among urban Native American children. The lack of intervention effect among adolescents reiterates the need for greater comprehension of personal, environmental, and behavioral constraints, influencing dietary self-efficacy and behavior.

This study investigated correlations among physical fitness, dietary intakes, activity levels, and body mass index (BMI) for 155 urban Native American youth, ages 5 to 18 years. Heights, weights, skinfold measurements, activity level, balance times, and dietary intakes were assessed. Presidential Physical Fitness (PPF) testing was completed with 82 youth. Age groups were examined for differences in energy and macronutrient intake, sedentary activities, activity level, and PPF achievement. Pearson and Spearman rho correlations were examined among dietary intakes, fitness, balance, and activity levels. The majority of youth (63%) were at risk for overweight or already overweight, and 59% were sedentary. BMI was correlated with age and PPF achievement for all youth, and with physical activity and frequency of television viewing for youth ages 9 to 18 years. No correlation was found between dietary intake and activity level. Culturally appropriate interventions for obesity should start early, focusing on decreasing sedentary activity and increasing opportunities for fitness.

Although obesity is a growing problem with Native American youth living on reservations, little research has been conducted examining the prevalence of obesity and correlations between age, body composition, dietary intake, and blood pressures (BP) for urban Native youth. The purpose of this study was to investigate the relationship of these variables in urban Native American youth. Height and weight were measured for 155 Native American youth, age 5-18 years, and the body mass index (BMI) was calculated and classified into percentile categories. Skinfold thicknesses at the biceps, triceps, suprailiac, and subscapular sites, arm and waist circumferences, and systolic (SBP) and diastolic (DBP) blood pressures were also measured. There was a high proportion of obesity (>95 percentile) for youth in all age groups. The prevalence was 38% for the 5-10-year-olds and 45% for the 11-18-year-olds youth. There were no significant correlations between SBP and DBP and dietary variables. Mean SBP and DBP increased with increasing BMI percentiles. Stepwise regression analyses showed that waist circumference, age, and BMI were strong predictors for SBP, while waist circumference and age were predictors for DBP in the total sample. The findings suggest that overweight/obesity is very prevalent among urban Native American youth and the increased adiposity is associated with increased SBP and DBP., (Copyright 2002 Wiley-Liss, Inc.)

Objective: This study investigated body-image perceptions among Native American youth., Research Methods and Procedures: A modified and validated body-image measure for use with Native American youth was utilized in a cross-sectional assessment of 155 urban Native American youth attending an after-school program in Minneapolis, Minnesota. The youth (ages 5 to 18 years) expressed their perceptions of current and ideal body image, which allowed assessment of satisfaction or dissatisfaction. Body sizes perceived as healthy or most likely to develop diabetes were also communicated. Heights and weights were measured, and body mass index was calculated., Results: When asked to identify their ideal body figure, younger children selected thinner figures than adolescents, and overweight youth chose ideal figures similar to those of normal-weight youth. The mean body dissatisfaction of the youth was +/-0.99 and +/-1.49 body figures for boys and girls, respectively. Examination of the direction of body dissatisfaction revealed that 41% of the boys and 61% of the girls expressed a desire to be thinner. Those expressing the greatest dissatisfaction were overweight girls (>95th percentile). On a scale from one to eight, the median of the body image viewed as the healthiest was 4.0, whereas that most likely to develop diabetes was 8.0., Discussion: These results suggest that urban Native American youth are dissatisfied with their body size and that most acknowledge the diabetes risk associated with overweight, which implies that they may be receptive to obesity prevention measures.