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In the United States, the prevalence of childhood overweight and obesity has reached epidemic levels, with U.S. Hispanic children, a sub-group mainly composed of children of Mexican decent, disproportionately affected. Prior research has suggested that Mexican parents may view overweight in early childhood as desirable; however, it is unclear if this is still the case. Therefore, this qualitative study explored the beliefs of 11 Mexican parents of preschoolers regarding weight and health. Following coding and clustering of themes from the transcribed audio-recorded meetings, six patterns were identified: (a) meanings and relationships about excess weight in childhood and child health, (b) causes of overweight and obesity, (c) uncertainty about knowing and not knowing, (d) from Mexico to America: enticements of a new land and time as a commodity, (e) the effects of society on personal and parental goals: the work of parenting in the United States, and (f) identified needs and action strategies. In summary, parents involved in this group discussion readily associated overweight/obesity with poor mental and physical health; however, they were uncertain how they would 'know' if their children were overweight. [ABSTRACT FROM AUTHOR]

Although tobacco use is the leading contributor to death and disability in the United States, allied health professionals often lack knowledge of smoking cessation techniques. The objective of this study was to identify the extent to which undergraduate dietetics programs (referred to as didactic programs in dietetics [DPD]) teach about tobacco and smoking cessation interventions and also DPD directors' opinions regarding tobacco and smoking cessation in dietetics education. All DPD directors in the United States (n = 231) were sent a questionnaire to assess programs' and directors' demographics, courses that included tobacco and smoking cessation education, and directors' opinions pertaining to tobacco and smoking cessation education. The response rate was 49% (n = 113). On average, DPD directors did not agree that tobacco and smoking cessation education should be a formal part of undergraduate dietetics programs and that it is not as important as other content areas required of dietetics students. Just 37% of directors believed that a dietitian's job responsibility included educating patients on smoking cessation. Only 7% of DPD directors had formal education on smoking cessation and tobacco use, but 53% had formal education on behavior modification. More than half of DPD programs (56%) did not offer any courses that provided tobacco and smoking cessation education. These results indicate that most undergraduate dietetics programs do not incorporate tobacco and smoking cessation education in their curricula. Dietetics and other allied health educators could consider including smoking cessation education in their curricula to ensure that future health professionals can contribute to Healthy People 2010 objectives related to smoking cessation. [ABSTRACT FROM AUTHOR]

Television viewing is ubiquitous in adolescent culture, but the influence of television characters on adolescent behaviours and social norms is not well understood. We conducted a content analysis of 10 television programmes frequently watched by 12- to 17-year-olds in the US media market. From these data, a survey was developed to determine how adolescents interact with, and are influenced by, television programmes, especially in relation to bodyweight, sex appeal, and food and beverage consumption. The survey was posted online, and students (12-19 years) from across the state of Arizona, USA, completed it electronically (n = 524). Data were assessed by tabulation, principal axis factor analysis and linear regression analysis. The results showed 12% of sample members had a body mass index (BMI)-for-age over the 95th percentile, 50% reported watching >2 h of television each day, and 59% reported accruing < 60 min of exercise and physical activity each day. Over 35% of respondents indicated eating pizza and pasta frequently. Beer and wine were seen as the most frequently consumed beverages on television, while 63.9% of sample members reported soda as their personal beverage of choice. Factor extraction from the survey indicated a three-factor solution ('sex appeal', 'TV viewers and perceivers', 'TV viewers and doers') provided the best conceptual explanation of the data, accounting for 34.7% of the total variance. Significant predictors (r2 = 0.448) of BMI-for-age included urbanicity (beta = 5.6), gender (beta = -14.5) and survey questions related to bodyweight perceptions. Our data showed that television's focus on sex appeal, thinness and alcohol may have a powerful impact on adolescents' self-esteem, body satisfaction and health behaviours. Innovative approaches related to decreased television viewing, household eating environment and media literacy warrant further exploration. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States. METHODS: We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C. RESULTS: Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%-17% and 13%-23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks. CONCLUSIONS: Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study dietary intake and body mass index (BMI) patterns among US adults, stratified by snacking patterns. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the study sample. Snacking episodes were defined as a 'food and/or beverage break', and subjects were classified as morning, afternoon, evening, multiple or never snackers. SUBJECTS/SETTING: Our study included data from 1756 men and 1511 women who provided two nonconsecutive, multiple-pass 24-h dietary recalls. STATISTICAL ANALYSES: Mean values of each subject's two 24-h recalls were used for analyses, and data were analysed using the Statistical Package for the Social Sciences (SPSS) for Windows and SUDAAN. RESULTS: Compared with women, men were more likely to be evening, multiple or never snackers. Male multiple snackers had significantly higher energy intakes than did afternoon and never snackers, whereas female multiple snackers had higher energy intakes than did morning, evening and never snackers. At the same time, male and female multiple snackers had more prudent energy-adjusted intakes of protein, cholesterol, calcium and sodium. Coffee, cola, milk, ice cream and fruits were among the most frequently consumed snacks by men and women. The BMI did not differ significantly across snacker categories. CONCLUSIONS: These data indicate that snacking patterns have some effects on energy and nutrient intakes but not on BMI. Snack food choices remain a concern, especially beverages, including those that are sweetened. Vegetables and fruits as snacks should be encouraged. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cigarette smoking is a major risk factor for several chronic oxidative diseases that can be ameliorated by antioxidants. OBJECTIVES: This study identified the typical dietary intakes and the major food group contributors of the antioxidants beta-carotene, vitamin C, and vitamin E by smoking status. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the current sample (n = 6749), who were categorized as non- (n = 3231), former (n = 1684), and current (n = 1834) smokers. In the CSFII, individuals' food intakes were estimated with two 24-h dietary recalls. Data were analyzed by using a chi-square test with a simultaneous Fisher's z test, analysis of variance with Scheffe's test, multivariate analysis of covariance, and analysis of covariance with Bonferroni adjustment for multiple comparisons. RESULTS: The sample consisted of 3707 men and 3042 women. Current smokers tended to be younger with less education and lower incomes than nonsmokers and former smokers. The average body mass index (in kg/m(2)) of current smokers was 25.8, the lowest of the 3 groups. Current smokers had the lowest dietary antioxidant intake. Fatty foods such as luncheon meats, condiments and salad dressings, and ground beef contributed more to the antioxidant intakes of current smokers than to those of the other 2 groups, whereas fruit and vegetables contributed less. Current smokers consumed the fewest numbers of servings of all nutrient-bearing groups in the food guide pyramid, except the meat group. CONCLUSION: Future interventions should target the clustering of cigarette smoking and other unhealthy lifestyle habits, eg, an imprudent diet. Copyright © 2000 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

Objective: Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them., Design: Eight focus groups were conducted to explore attitudes and behaviors related to CVV use., Setting: Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ., Participants: Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households., Phenomenon of Interest: Perceived barriers to CVV use and strategies used to maximize their purchasing value., Analysis: Transcripts were analyzed using a general inductive approach to identify emergent themes., Results: Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power., Conclusions and Implications: Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences., (Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: The authors assessed associations between body weight perception and weight loss strategies., Participants: They randomly selected male and female college students (N = 38,204)., Methods: The authors conducted a secondary data analysis of the rates of weight loss strategies and body weight perception among students who completed the National College Health Assessment survey., Results: Half of respondents (50%) were trying to lose weight, although only 28% of students were overweight or obese. Also, 12% of respondents had inaccurate body weight perception. Women and men with inaccurate body weight perception were significantly more likely to engage in inappropriate weight loss strategies than were those with accurate body weight perception. Of all students attempting to lose weight, 38% used both diet and exercise., Conclusions: These data show that college students are interested in weight loss and that body weight perception plays an important role in the desire to lose weight.

Epidemiologic evidence suggests that dietary monounsaturated fatty acids (MUFA) may have a beneficial health effect. Twenty-four-hour dietary intake data collected on 10-year-olds from 1978 to 1994 and on children and adults (ages 0-30 years) were examined for time, age, gender, ethnic, and geographic location differences in MUFA intake. Children's percent energy from MUFA decreased significantly from 1978 (14.1%) to 1994 (11.9%) with intake of oleic acid decreasing from 33.9 g/day (1973) to 25.7 g/day (1994). In 1994-96, percent energy from MUFA was 13% for children and adults aged 12 to 30 years, with 5% from palmitoleic acid and 93% from oleic acid. Males and blacks had significantly higher MUFA intake across all age groups than females and whites. Intakes of MUFA increased from 0 to 11 years of age to young adulthood (12-19 years), with no further increase at 20 to 30 years of age. Intakes of MUFA were lowest in the Northeast and highest in the Midwest. There were differences in food sources of MUFA by age group. For children 0 to 5 years of age, major sources were whole milk, peanut butter, 2% milk, and French fries; for children 6 to 11 years of age, major sources were whole milk, peanut butter, French fries, and 2% milk; for children 12 to 19 years of age, French fries, salt snacks, whole milk, and meat pizza were the major sources; for adults, French fries, whole milk, potato chips, and ground beef were the most common sources of MUFA. U.S. children and adults displayed temporal trends and demographic differences in intakes and food sources of MUFA. The implications of these changes and differences on biologic risk factors for specific chronic diseases warrant further investigation.

Race-, gender- and age-specific differences in dietary micronutrient intakes of 1- to 10-year-old US children were evaluated. Three-day, dietary intakes from the US Department of Agriculture's Continuing Survey of Food Intakes by Individuals were evaluated. Data from 1895 children (967 males, 928 females; 1,540 Whites, 355 Blacks) who resided in the 48 conterminous states were analyzed. Micronutrient intakes, intakes as percent of the Recommended Dietary Allowance (RDA) and percent of children who consumed < or =67% of the RDA were computed. Black males compared with White males, Black females compared with White females and White females compared with White males had significantly lower dietary intakes for several micronutrients. More Black males than White males had intakes < or =67% of the RDA for vitamin E, calcium and zinc. Blacks and female children were at a greater risk for vitamin A, vitamin E, calcium, iron and zinc deficiency.

The influence of creatine supplementation on substrate utilization during rest was investigated using a double-blind crossover design. Ten active men participated in 12 wk of weight training and were given creatine and placebo (20 g/day for 4 days, then 2 g/day for 17 days) in two trials separated by a 4-wk washout. Body composition, substrate utilization, and strength were assessed after weeks 2, 5, 9, and 12. Maximal isometric contraction [1 repetition maximum (RM)] leg press increased significantly (P < 0.05) after both treatments, but 1-RM bench press was increased (33 +/- 8 kg, P < 0.05) only after creatine. Total body mass increased (1.6 +/- 0.5 kg, P < 0.05) after creatine but not after placebo. Significant (P < 0.05) increases in fat-free mass were found after creatine and placebo supplementation (1.9 +/- 0.8 and 2.2 +/- 0.7 kg, respectively). Fat mass did not change significantly with creatine but decreased after the placebo trial (-2.4 +/- 0.8 kg, P < 0.05). Carbohydrate oxidation was increased by creatine (8.9 +/- 4.0%, P < 0.05), whereas there was a trend for increased respiratory exchange ratio after creatine supplementation (0.03 +/- 0.01, P = 0.07). Changes in substrate oxidation may influence the inhibition of fat mass loss associated with creatine after weight training.

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.

Purpose: To compare dietary intakes of nonsmoking adults married to smokers or nonsmokers., Design: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals (CSFII), 1994 to 1996 (response rate = 76.1% for 2 days of dietary intake). Nonsmoking adults aged 18 and older were grouped according to the smoking status of their spouse., Setting: In-home interviews in all 50 states and Washington, D.C., Subjects: The selected sample included 757 men and 754 women who were married to nonsmokers, and 197 men and 262 women who were married to smokers., Measures: Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared using chi 2 and analysis of covariance., Results: Men and women married to smokers had greater (p < or = .025) energy-adjusted intakes of total and saturated fat but significantly lower (p < or = .05) energy-adjusted intakes of fiber and vitamin A. Men married to smokers consumed significantly more (p < .025) energy-adjusted cholesterol and ethanol but significantly less calcium (p = .026); women married to smokers consumed significantly less (p = .014) energy-adjusted folate. Men married to smokers consumed significantly more (p < or = .05) alcoholic beverages, coffee, and soft drinks; women married to smokers consumed significantly less water (p = .014) but more cheese and table sweeteners (p < or = .05)., Conclusions: Nonsmoking men and women who were married to smokers had compromised dietary intakes. Nonsmoking men whose wives smoked, in particular, had unhealthy diets due to elevated intakes of fat and cholesterol and low intakes of vitamin A, calcium, and fiber. Health professionals should continue to provide tobacco cessation instruction and dietary guidance, but also be aware of at-risk patients' immediate family members who likely share an increased risk of disease because of poor diet quality and exposure to environmental tobacco smoke.

Epidemiological investigations repeatedly show that the regular consumption of dark green and cruciferous vegetables, tomatoes and citrus fruits in particular is related to reduced cancer risk. We used the 1994-1996 Continuing Survey of Food Intakes by Individuals to examine the types of fruits and vegetables consumed by Americans. The analytic sample population, which consisted of 4806 men and women (25-75 y old) who completed two nonconsecutive 24-h recalls, consumed 3.6 +/- 2.3 servings of vegetables and 1.6 +/- 2.0 servings of fruit daily. Iceberg lettuce, tomatoes, French fried potatoes, bananas and orange juice were the most commonly consumed fruits and vegetables, accounting for nearly 30% of all fruits and vegetables consumed. The most popular items, lettuce and tomatoes, were consumed by 39-42% of the sample population during the reporting period. Fewer respondents (16-24%) consumed French fried potatoes, bananas or orange juice. Only 3% of the sample consumed broccoli during the reporting period. White potato consumption averaged 1.1 servings daily, with French fried potatoes representing 0.4 serving. Tomato product consumption averaged 0.5 serving daily, dark green vegetable consumption averaged 0.2 serving daily and citrus, berries or melon consumption amounted to nearly 0.8 serving daily. These data indicate that Americans are consuming more fruits and vegetables but that dark green and cruciferous vegetable intake is low.

Purpose: To examine relationships between cigarette smoking, alcohol use, and dietary intake., Design: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals, a nationwide probability sample conducted from January 1994 through January 1997 (n = 23,602; response rate = 80%), were selected. Adults ages 19 years and older were grouped according to their smoking and drinking habits. Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared., Setting: In-home interviews were conducted in the 50 states and the District of Columbia., Subjects: The selected sample (n = 6745) included 3229 nonsmokers, 1701 former smokers, and 1808 current smokers, and 2284 abstainers, 2713 occasional drinkers, 1000 moderate drinkers, and 748 liberal drinkers., Measures: Responses to standard questionnaires were examined by Student's t-test, chi 2, one-way analysis of variance, and univariate and multivariate analyses of covariance., Results: Men were more likely than women to be current smokers and liberal drinkers (64% vs. 40% and 62% vs. 38%). For both, the use of cigarettes and alcohol was closely related. An additive relationship was observed between smoking/drinking classification and lower food group servings and nutrient intakes. Although cigarette and alcohol use may have been underreported, these findings support previous ones showing poor food choices along with lower nutrient intakes as smoking and drinking increase., Conclusions: Smoking and drinking habits may alter individuals' food selections and nutrient intakes. Future interventions for health promotion may achieve greater success by targeting multiple risk factors simultaneously or sequentially.

Objective: The purpose of this study was to determine vitamin C intakes among American schoolchildren. We investigated the leading sources of vitamin C in children's diets, the leading vegetables and fruits consumed by children and differences in dietary intake associated with vitamin C consumption., Methods: Data from 1,350 7- to 12-year-old and 908 13- to 18-year-old schoolchildren were obtained from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). The children were stratified by age and gender and then split into three vitamin C consumption groups based upon two 24-hour recalls: low (0 to 30.0 mg), marginal (30.1 to 59.9 mg), and desirable (>60.0 mg). Data were analyzed by tabulation and by ANOVA followed by post hoc Scheffe's test. Outcome measures included food groups and energy-adjusted intakes of micro- and macronutrients., Results: Among the 7- to 12-year-olds, 12% of boys and 13% of girls had mean vitamin C intakes that were less than 30 mg/day, and, among 13- to 18-year-olds, 14% of boys and 20% of girls had low vitamin C intakes. In addition to consuming significantly more vitamin C, children with desirable vitamin C intakes also consumed significantly more (p <0.001) energy-adjusted folate and vitamin B6; children with low vitamin C intakes tended to have significantly greater (p <0.001) energy-adjusted intakes of fat and saturated fat. Children with desirable vitamin C intakes consumed significantly more (p <0.006) high-vitamin C fruit juice, low-vitamin C vegetables and whole milk. Children with low vitamin C intakes on average consumed two daily servings of vegetables and fruits, of which less than 1/5 of a serving was citrus, while children with desirable vitamin C intakes consumed an average of one daily serving of citrus., Conclusions: A considerable number of children drastically under-consumed vitamin C and total vegetables and fruits. Overall, children with desirable vitamin C intakes had healthier diets, including more milk and vegetables, than did their peers with low vitamin C intakes. Health care professionals should continue to promote at least five daily servings of vegetables and fruits and should advise parents that at least one of these should be rich in vitamin C.

Faced with a dwindling number of clinical sites for training dietetics students, we incorporated a standardized patient scenario of a 17-year-old pregnant woman into a nutrition counseling course. A young woman was hired to be the patient and was trained extensively. Each student signed up for a 20-minute block of time to assess her and provide nutrition instruction, after which the standardized patient and course instructor provided individualized feedback to each student. Students then completed a brief questionnaire related to the standardized patient session. Overall, student response to the standardized patient session was positive, and students believed standardized patients should be included formally in undergraduate training. The students noted that the standardized patient session allowed them to be trained and evaluated objectively. Because of their ease in building rapport with the standardized patient, students reported that they were able to provide more in-depth education. They also appreciated the immediate and detailed performance review provided by the standardized patient and the instructor. We conclude that standardized patient sessions provide a great service to dietetics students, and plans to develop another standardized patient scenario that students can follow up throughout the continuum of care are underway.

Background: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries., Methods: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources. Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th (X75) and 25th (X25) percentile values of the variable. The difference, bX75 - bX25, is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100000 males aged 45-74 years. Reported P values are two-sided., Results: Prostate cancer mortality was inversely associated with estimated consumption of cereals (bX75 - bX25 = -7.31 deaths; P = .001), nuts and oilseeds (bX75 - bX25 = -1.72 deaths; P = .003), and fish (bX75 - bX25 = -1.47 deaths; P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective (P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables (P = .003)., Conclusions: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials.

The Nutrient Intake Report (NIR) is based on a 7-day dietary recall questionnaire used previously in research for dietary assessment and adapted for clinical use. Used to provide information and counseling as part of total patient care, the NIR acts as a cornerstone for dietary education and interaction between physician, registered dietitian, and patient. The NIR is ordered by physicians or registered dietitians, scanned and assessed by a registered dietitian, and incorporated into the laboratory section of the medical record. It documents the patient's dietary intake in the context of his or her diagnosis and general health status. The NIR also opens a dialogue between physicians and registered dietitians. Incorporation of the NIR into the medical record makes the work of the registered dietitian available to other health practitioners, which is welcome in an era when licensing and reimbursement are contingent on systematic documentation of dietary assessment and its role in patient care.