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The purpose of this study was to determine the content validity, internal consistency, and construct validity of the Child Nutrition and Physical Activity (CNPA) screening tool for obesity risk. The sample consisted of 2230 children aged 2 to 18 years old, with about 39% of the children being overweight or obese. An expert panel supported the content validity of the CNPA screener. Principal component factor analysis of perception/confidence/importance items yielded 2 factors with acceptable internal consistency. Construct validity of the CNPA screener was supported by associations with weight status. The CNPA screener demonstrates moderate reliability and validity; thus, further development will be needed.

African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.

Literature is lacking on the impact of diet quality on glycemic control in those with type 2 diabetes (T2DM), especially African Americans with T2DM. 211 African American adults with T2DM and A1c ≥ 7.0% were randomized into intervention (26 sessions) and control (2 sessions) for an 18-month randomized community-based control trial, Lifestyle Improvement Through Food and Exercise (LIFE), assessing the impact of culturally-relevant lifestyle education on glycemic control. Participants lived in low-income Chicago-area neighborhoods and had regular medical care. Diet quality was assessed via 24-hour recall and translated into the Alternative Healthy Eating Index 2010 (AHEI-2010). AHEI-2010 total scores (0-110: higher score=healthier pattern) for intervention (n=95) and control (n=92) respectively were baseline: 47.4 ± 1.1 vs. 51.2 ± 1.1, 12 months: 51.4 ± 1.0 vs. 50.5 ± 1.1, 18 months: 50.3 ± 1.2 vs. 51.6 ± 1.2. Using repeated measures ANOVA, the AHEI-2010 18 month increase from baseline was significantly higher in the intervention group, df (2, 370), F (3.18), p=0.043. A1c% decline over 18 months (intervention: 9.1 ± 0.2 to 8.5 ± 0.2; control: 8.9 ± 0.2 to 8.6 ± 0.2, p Disclosure B. Tahsin: None. K.S. Keim: None. L. Fogelfeld: None. L. Fogg: None. E. Lynch: None. Funding National Institutes of Health

BACKGROUND: African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. RESEARCH DESIGN AND METHODS: This randomized controlled trial (n = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. RESULTS: At 6 months, A1c decreased significantly more in the intervention group than the control group (− 0.76 vs − 0.21%, p = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months − 0.63 intervention vs − 0.45 control, p = 0.52). There was a decrease in A1c over 18 months in both the intervention (β = − 0.026, p = 0.003) and the comparison arm (β = − 0.018, p = 0.048) but no difference in trend (p = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p = 0.002) and diet quality (4.0 vs − 0.5 point change, p = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent–youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Serum prealbumin (PAB) is commonly used to assess protein status and is often used to monitor the response to nutrition support. However, during inflammation, the liver synthesizes acute-phase proteins such as C-reactive protein (CRP) at the expense of PAB.The purpose of this retrospective study was to determine whether changes in PAB reflect the delivery of adequate nutrients or changes in inflammatory status in hospitalized adults (≥18 years) receiving enteral nutrition (n = 154).Protein and energy intake were compared to changes in PAB, assessed at baseline and twice weekly. C-reactive protein was assessed when PAB was18 mg/dL to determine the presence and severity of inflammation.In a sample of mostly critically ill patients, there was no significant difference in change in PAB for those receiving ≥60% of calorie needs (2.74 ± 9.50 mg/dL) compared to60% of calorie needs (2.48 ± 9.36 mg/dL; P = .86). Changes in PAB correlated only with changes in CRP (r = -0.544, P.001). In a subgroup analysis of 62 patients with repeated measures of PAB and CRP, PAB increased significantly only in the bottom 2 tertiles for calorie delivery and the lowest tertile for protein delivery.These results indicate that PAB may not be a sensitive marker for evaluating the adequacy of nutrition support in critically ill patients with inflammation. Only change in CRP was able to significantly predict changes in PAB, suggesting that an improvement in inflammation, rather than nutrient intake, was responsible for the increases in PAB levels.

This study identified program delivery preferences and barriers to physical activity and healthy eating. Ninety-nine urban dwelling American Indians completed a questionnaire at powwows, community events, and a community health center. Most frequently selected program delivery preferences were coaching or other human contact, with fewer willing to use computer or telephone coaching. Fifty-six selected attending 8, 12, or 16 sessions. Most frequently selected barriers to physical activity were lack of time ( n = 48) and pain from existing problems ( n = 33). Frequently identified barriers to eating healthy foods included expense ( n = 42), uncertainty regarding what foods are healthy ( n = 25), extra time needed for preparation ( n = 22), and lack of knowledge of how to prepare healthy food ( n = 22). Findings showed the need for programs to focus on decreasing the barriers of time for physical activity and healthy eating and encourage doing organized physical activity (not necessarily exercise) with others to increase physical activity.

Behavior change theories and models, validated within the field of dietetics, offer systematic explanations for nutrition-related behavior change. They are integral to the nutrition care process, guiding nutrition assessment, intervention, and outcome evaluation. The American Dietetic Association Evidence Analysis Library Nutrition Counseling Workgroup conducted a systematic review of peer-reviewed literature related to behavior change theories and strategies used in nutrition counseling. Two hundred fourteen articles were reviewed between July 2007 and March 2008, and 87 studies met the inclusion criteria. The workgroup systematically evaluated these articles and formulated conclusion statements and grades based upon the available evidence. Strong evidence exists to support the use of a combination of behavioral theory and cognitive behavioral theory, the foundation for cognitive behavioral therapy (CBT), in facilitating modification of targeted dietary habits, weight, and cardiovascular and diabetes risk factors. Evidence is particularly strong in patients with type 2 diabetes receiving intensive, intermediate-duration (6 to 12 months) CBT, and long-term (>12 months duration) CBT targeting prevention or delay in onset of type 2 diabetes and hypertension. Few studies have assessed the application of the transtheoretical model on nutrition-related behavior change. Little research was available documenting the effectiveness of nutrition counseling utilizing social cognitive theory. Motivational interviewing was shown to be a highly effective counseling strategy, particularly when combined with CBT. Strong evidence substantiates the effectiveness of self-monitoring and meal replacements and/or structured meal plans. Compelling evidence exists to demonstrate that financial reward strategies are not effective. Goal setting, problem solving, and social support are effective strategies, but additional research is needed in more diverse populations. Routine documentation and evaluation of the effectiveness of behavior change theories and models applied to nutrition care interventions are recommended.

Diabetes continues to affect minority populations disproportionately, especially Native Americans. Identifying culturally-specific definitions of health and diabetes is critically important for relevant and effective diabetes prevention programs. Qualitative interviews were conducted with 20 Native American men from two tribal clinics. Verbatim transcripts were analyzed by means of grounded theory, to identify culturally-specific definitions of health and diabetes. The men defined health in terms of physical capabilities and presence of disease. Conversely, the men viewed diabetes as an inexorable downward course that slowly manifests itself through various complications and ultimately results in death. Men feared for their own diagnoses as well as the diagnosis of family or community members whom they considered to be at-risk. Additional information about the perceptions of health and diabetes in racial and ethnic minority populations will significantly contribute to the development of effective diabetes prevention programs.

OBJECTIVE To identify commonly consumed foods and the relationship of health perception on food intakes. METHODS One hundred seventy-five Native American women completed a 1-d or 4-d food records. Perceptions of health value were obtained by the food sort method. Frequency analyses identified commonly consumed foods. Relations between intakes and perception of health value were evaluated by Spearman's correlations. RESULTS Coffee and tea, soda (diet and regular), white bread, and table fats were the most commonly consumed foods in both samples. Health value had little impact on consumption. CONCLUSIONS Understanding the foods consumption and the role of perception on intakes allows for targeted nutrition education programming.

Objective To determine the personal attributes and job competencies that are necessary for the job success of Expanded Food and Nutrition Education Program (EFNEP) paraprofessionals as perceived by EFNEP professionals. Design A qualitative descriptive design and a 3-round modified Delphi methodology was used. Participants A convenience sample of 14 state and 20 county EFNEP professionals participated in all 3 Delphi rounds. The response rates for state and county professionals for all 3 Delphi rounds were 70% and 91%, respectively. Variables Measued Personal attributes and job competencies were generated and the level of importance was determined. Analysis An independent t test was employed to determine differences between importance scores by professional position. Results Thirty-seven personal attributes, 18 job competencies prior to hire, and 43 job competencies after training were generated and the majority were very important to important. County EFNEP professionals tended to score personal attributes and job competencies as more important than state EFNEP professionals. Implications These personal attributes and job competencies prior to hire can guide hiring decisions and initial training content. The job competencies after training can shape content for inservice training.

The Lifestyle Improvement through Food and Exercise (LIFE) study is a community-based randomized-controlled trial to measure the effectiveness of a lifestyle intervention to improve glycemic control among African Americans with type 2 diabetes attending safety net clinics. The study enrolled African American adults with a diagnosis of type 2 diabetes and HbA1c ≥ 7.0 who had attended specific safety net community clinics in the prior year. 210 patients will be enrolled and randomized to either the LIFE intervention or a standard of care control group, which consists of two dietitian-led diabetes self-management classes. The LIFE intervention was delivered in 30 group sessions over 12-months and focused on improving diet through dietitian-led culturally-tailored nutrition education, increasing physical activity through self-monitoring using an accelerometer, increasing ability to manage blood sugar through modifications to lifestyle, and providing social support for behavior change. In addition to the group sessions, peer supporters made regular telephone calls to participants to monitor progress towards behavioral goals and provide social support. The 12-month intervention phase was followed by a six-month maintenance phase consisting of two group sessions. The primary outcome of the study is change in A1C from baseline to 12-months, and an additional follow-up will occur at 18-months. The hypothesis of the study is that the participants in the LIFE intervention will show a greater improvement in glycemic control over 12-months than participants in the control group.

There is no consensus whether resting energy expenditure (REE) following orthotopic liver transplantation (OLT) is altered.The objectives of this investigation were to describe changes in measured REE (mREE) using indirect calorimetry in 25 OLT patients on days 5, 10, and 15 after baseline (within 72 hours following OLT) and compare mREE changes with those calculated with 2 predicted equations for energy expenditure (pREE): the Harris-Benedict and Schofield equations.Patients were 57 ± 5.4 years of age, 44% were male, 36% were black, and 72% had liver disease of viral etiology. Measured REE (at baseline and days 5, 10, and 15, per kcal/d: 1832 ± 952, 1565 ± 383, 1538 ± 345, 1578 ± 418) and kcal per kilogram of body weight (22.7 ± 12.8, 18.4 ± 4, 18.7 ± 3.8, 21 ± 6.5) did not change over time. In contrast, changes in pREE based on either the Harris-Benedict (P.001) or Schofield (P = .006) equation using measured weights at each corresponding time point and lowest body weight during the study to estimate dry weight were significant.Wide ranges in both mREE and mREE expressed per kilogram of body weight at each study time point were observed in contrast to pREE, which declined by day 15. The observed differences in mREE over time suggest indirect calorimetry is indicated if available following OLT. Additional research is warranted to determine the most appropriate predictive equation with suitable stress factors to use when indirect calorimetry is not available.

Due to increasing pressures to document the effectiveness of educational programs, a project was undertaken to develop impact indicators and accompanying evaluation questionnaires for four of seven Dietary Guidelines for Americans. The results of field testing a 12-item knowledge and 16-item behavior change evaluation questionnaire for the “healthy weight” dietary guideline are presented. A pre-, post-, and 3- to 6-month delayed postassessment measurement design was selected to be used following completion of diverse multi-session weight management nutrition education programs designed by each participating state. Seven states in the Extension system collected and submitted both pre- and postdata; one state submitted pre-, post-, and delayed postdata. Results indicate small gains in knowledge and significant improvements in behaviors related to weight management in the broad categories of food behavior, exercise behavior, and behavior modification changes. However, a state by test interaction was identified for food behavior and behavior modification practices scores. States that showed no change for those measures tended to have higher pretest scores but the statistical results may have been affected by small numbers of participants in some states. This study suggests that use of a standard set of impact indicators, knowledge and behavior questionnaires to assess programming impact at different locations may be feasible. It would be important to consider programmatic similarities, such as program length and content, and differences in pre-entry data before aggregation of data occurs.

Focus group discussions are being used more often during the formative phase of nutrition education program development. This article discusses focus group procedure adaptations to increase effectiveness with low-income Caucasian and Hispanic audiences for adults and thirdgrade children. Recruitment is more effective if the target audience knows the recruiter. Methods such as posters and letters do not work. The facility needs to be considered safe and easy to get to. Some children need focus group discussions of less than 1 hour in length or some type of activity to break the monotony of the session. The use of a “talking stick” is also helpful to allow all children to be heard. It was observed that the Hispanic participants were not as verbal as the Caucasian participants. More Hispanic focus groups needed to be conducted to obtain the same amount of diversity in information as was obtained from the Caucasian groups.

Objectives Health-related characteristics and habits and food choices of young adults were compared for three groups: college students, college graduates, and nonstudents. Design Subjects completed a mailed survey that included questions about demographics, attitudes, and behaviors and a food frequency questionnaire. Main outcome measures were health-related characteristics and habits and food choices. Subjects Female (n=758) and male (n=580) 18- to 24-year-olds in nine states who were selected randomly by zip code in each state. The response rate averaged 43% for all states. Statistical analyses performed Analysis of variance or χ 2 tests were applied to health-related personal characteristic variables and the Kruskal-Wallis analysis of variance was applied to food consumption variables for women and men separately. Results According to self-reported heights and weights, female nonstudents were more often overweight than female students or graduates. Nonstudents of both genders reported smoking more often than students or graduates. College students and graduates ate more grain foods high in dietary fiber, more fruits and dark-green vegetables, and more lower-fat milk and meats than non students. Conclusions/applications Non students were at greater health risk for some chronic illnesses, because of poorer health habits and food choices, than were college students and graduates. The behavior of nonstudents implies weaker response to messages promoting weight control, smoking cessation, and observance of the Dietary Guidelines for Americans than behavior exhibited by students or college graduates. Health promotion efforts could be enhanced by identifying demographic, educational, situational, and formative influences on positive health and dietary behaviors of young adults.

A mail survey was developed to determine the behaviors associated with eating vegetables and fruits and if there was a relationship between young adults’ perceptions of vegetables and fruits and relative intake. The survey collected demographic information and used a repertory grid and a food frequency questionnaire. Respondents included 219 males and 289 females. The most frequently eaten vegetables and fruits were orange or grapefruit juice, French fries and fried potatoes, other potatoes, other fruit juice, and green salad. Many of the respondents added fat to cooked vegetables and salads. Few respondents ate vegetables at lunch, dinner, or snack time or fruit for desserts or snacks. Students had fewer behaviors where they added fat to vegetables and salads and were more likely to eat vegetables at lunch and snack time. The factor analyses showed perceptions about vegetables and fruits that included both social and sensory aspects and health aspects. Only perceptions of social and sensory aspects of vegetables and fruits were related to intake. Perceptions of health aspects of vegetables and fruits did not have a consistent or significant relationship with intake. The results suggest that social and sensory aspects of vegetables and fruits may be important messages to include in nutrition education programming for young adults.

It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

The objective of this cross-sectional study was to describe the level of prescriptive authority and explore barriers to obtaining prescriptive authority of registered dietitians in acute health care facilities. A sample of 1,500 clinical nutrition managers was electronically surveyed; data from 351 respondents (23% response rate) were analyzed using descriptive statistics and χ 2 tests. Many (54%) respondents reported no prescriptive authority, 36% reported dependent prescriptive authority, and 10% reported independent prescriptive authority. Most (95%) respondents with no prescriptive authority and (89%) with dependent prescriptive authority valued independent prescriptive authority. The two most commonly listed barriers to independent prescriptive authority were opposition (52% no prescriptive authority, 48% dependent prescriptive authority) and liability (40% no prescriptive authority, 48% dependent prescriptive authority). Forty-five percent of respondents with independent prescriptive authority reported the route to independent prescriptive authority was via clinical privileges. Based on the responses of this sample, the authors conclude the majority of respondents do not have, but value, independent prescriptive authority. The issue of liability as a barrier to independent prescriptive authority might need further study to determine reasons why liability is perceived as a barrier to independent prescriptive authority.

To identify commonly consumed foods and the relationship of health perception on food intakes.One hundred seventy-five Native American women completed a 1-d or 4-d food records. Perceptions of health value were obtained by the food sort method. Frequency analyses identified commonly consumed foods. Relations between intakes and perception of health value were evaluated by Spearman's correlations.Coffee and tea, soda (diet and regular), white bread, and table fats were the most commonly consumed foods in both samples. Health value had little impact on consumption.Understanding the foods consumption and the role of perception on intakes allows for targeted nutrition education programming.

Objective To identify the core and secondary foods among Native-American women in Oklahoma and to determine their impact on nutrient and Food Guide Pyramid serving intakes. Design This descriptive study explored food intakes from 4-day weighed food records. Nutrient intakes were estimated using reference data used in national survey data. Subjects/setting Seventy-one Native-American women receiving services from three tribal health clinics in northeast Oklahoma. Statistical analyses performed A food-use frequency score was computed using frequencies of individuals consuming foods across each of 4 days of records. Leading contributors of nutrients and Food Guide Pyramid servings were identified from core and secondary foods. Results Thirty foods comprised the list of core foods, led by soda, coffee, and white bread. A majority of total energy, fat, saturated fat, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, carbohydrate, calcium, vitamin C, folate, discretionary fat, and added sugar were derived cumulatively from the core and secondary foods. Forty percent of fruit Food Guide Pyramid servings were accounted for by two core foods, bananas, and orange juice. More than half of meat and vegetable Food Guide Pyramid servings were derived from core and secondary foods. Conclusions Food patterning data are helpful in the development of effective nutrition education programs. We identified less nutrient-dense core foods that are contributing to discretionary fat and added sugar intakes. Targeted nutrition education programs for Native Americans should promote the nutrient-dense core and secondary foods, such as whole-wheat bread and fruit, while providing more healthful food alternatives to less nutrient-dense foods.

Introduction The prevalence of diabetes is disproportionately higher among minority populations, especially American Indians. Prevention or delay of diabetes in this population would improve quality of life and reduce health care costs. Identifying cultural definitions of health and diabetes is critically important to developing effective diabetes prevention programs. Methods In-home qualitative interviews were conducted with 79 American Indian women from 3 tribal clinics in northeast Oklahoma to identify a cultural definition of health and diabetes. Grounded theory was used to analyze verbatim transcripts. Results The women interviewed defined health in terms of physical functionality and absence of disease, with family members and friends serving as treatment promoters. Conversely, the women considered their overall health to be a personal issue addressed individually without burdening others. The women presented a fatalistic view of diabetes, regarding the disease as an inevitable event that destroys health and ultimately results in death. Conclusion Further understanding of the perceptions of health in at-risk populations will aid in developing diabetes prevention programs.

Objective The purpose of this study was to develop an understanding of body weight from emic perspectives of limited-income overweight and obese white women. Design In-depth individual interviews, including the use of contour drawings and body dissatisfaction parameters. Setting All methods were conducted in the homes of the research participants. Participants A purposeful sample of limited-income white women (N = 25), ages 19 to 44 years. Phenomena of Interest Personal perceptions of attractiveness, health, body weight, and body dissatisfaction. Analysis Transcripts were analyzed using content analysis. Triangulation of data was achieved by comparing data elicited by different methods in different sections of the interview. Results Disordered eating habits were common and considered consequences of social, economic, and familial pressures. Food was often used as a means of coping with life pressures. Social and economic barriers were identified as impeding the adoption of more healthful lifestyles. Weight loss was a low priority owing to financial, emotional, familial, and health care constraints. Conclusions and Implications Multidisciplinary programs addressing financial, emotional, and nutritional concerns may be the most effective for weight management among white limited-income women. Additional research is necessary to verify the results of this study with larger samples.

This study compared the continuing professional education (CPE) activities of registered dietitians (RDs) with those of dietetic technicians, registered (DTRs). A descriptive research study was used with data from the baseline survey evaluating the Commission on Dietetic Registration's (CDR) Professional Development Portfolio. The survey was sent to 3,530 randomly selected RDs and DTRs; 1,429 surveys were returned (40.5% response rate), with 41% of RDs contacted responding and 32% of DTRs responding. Guidance used when selecting CPE activities and type of CPE activity selected were measured. DTRs sought more guidance than RDs when selecting CPE activities (P=.001). A significantly higher percentage of RDs than DTRs selected lectures, workshops, journal clubs, satellite courses, exhibits, professional leadership, professional reading, and poster sessions as CPE activities (P

This study summarizes the perceptions towards the Professional Development Portfolio method of recertification and attitude towards professional development of dietetic professionals as measured in the national pilot study of the Portfolio . Portfolio compared to control respondents had greater awareness, and better understanding and knowledge of the Portfolio process after using the Portfolio guide. The perception that the Portfolio process will aid in maintaining competence did not differ between groups. The perception that self-reflection aided in determining career goals and confidence to conduct a learning needs assessment differed slightly between groups. Both groups had a positive attitude towards professional development and that continuing professional education (CPE) improved competence. All perceptions and attitudes were positive. The focus of CPE in foods, business, management, education, and research did affect the ability of dietetics professionals to find appropriate CPE. Rural and unemployed respondents had more difficulty finding appropriate CPE. The findings indicate that the Portfolio guide aides the dietetics professional using the Portfolio process and that the perception towards the Portfolio process is positive. Some dietetics professionals with different CPE focus had difficulty finding appropriate CPE, and this did not differ by control and Portfolio group. More innovative methods of CPE delivery may need to be considered for these practitioners.

PURPOSE This study was designed to develop and test an intervention for college students with type 1 diabetes. METHODS A diabetes program, "Control on Campus," and guide were developed based on the Expanded Health Belief Model and Social Learning Theory. Diabetes knowledge, attitudes, and behaviors were assessed preprogram, postprogram, and at follow-up for 3 intervention cohorts and a control group. RESULTS Reporting of HbAlc values and diabetes knowledge improved significantly as a result of the intervention compared with no increase in the control group. Furthermore, participants reported feeling more support on campus after the intervention, appeared to have overcome their fears associated with testing their blood glucose, reported an increased frequency of blood glucose testing, and were more likely to test when they felt their blood glucose level was low. CONCLUSIONS Overall, this research yielded substantial insight into the characteristics of college students with diabetes and was successful in designing and evaluating an intervention trial for this population.