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OBJECTIVE: To assess the coverage and consumer satisfaction with the Fight BAC! campaign and to evaluate the influence of the campaign on food safety knowledge, attitudes, and behaviors among a predominantly Latino population living in inner-city Hartford, Connecticut. DESIGN: A cross-sectional pre- and post-survey was administered to 500 Latino consumers in either English or Spanish. It included 30 food safety-related questions and information on the socioeconomic and demographic characteristics of participants. SETTING AND PARTICIPANTS: Respondents were selected from Latino households, with at least one child 12 years old or under, located in 5 predominantly Latino neighborhoods in inner-city Hartford. INTERVENTION: Fight BAC! media campaign. RESULTS: Seventy-three percent of respondents were exposed to at least one campaign media item and were highly satisfied with it. Recognition of the Fight BAC! logo increased from 10% to 42% between surveys (P <.001). Individuals exposed to the campaign were more likely to have a food safety knowledge score of at least 2 of a possible 4 compared with unexposed counterparts (odds ratio = 3.54; 95% CI 1.74-7.18; P <.001). They were also more likely to report defrosting meats in the refrigerator (14% vs 7%; P =.01). There was a dose-response association between the degree of campaign exposure and awareness of the term 'cross-contamination.' CONCLUSION AND IMPLICATIONS: Social marketing campaigns that take advantage of multiple culturally relevant media channels are likely to improve food safety awareness and bring about changes in food safety knowledge and attitudes among Latino consumers. [ABSTRACT FROM AUTHOR]

Aim: We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial., Methods: InclusionLatino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. ExclusionPain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine., Results: Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bermúdez-Millán et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims: The role of lay health workers in data collection for clinical and translational research studies is not well described. We explored lay health workers as data collectors in clinical and translational research studies. We also present several methods for examining their work, i.e., qualitative interviews, fidelity checklists, and rates of unusable/missing data., Methods: We conducted 2 randomized, controlled trials that employed lay health research personnel (LHR) who were employed by community-based organizations. In one study, n = 3 Latina LHRs worked with n = 107 Latino diabetic participants. In another study, n = 6 LHR worked with n = 188 Cambodian American refugees with depression. We investigated proficiency in biological, behavioral, and psychosocial home-based data collection conducted by LHR. We also conducted in-depth interviews with lay LHR to explore their experience in this research role. Finally, we described the training, supervision, and collaboration for LHR to be successful in their research role., Results: Independent observers reported a very high degree of fidelity to technical data collection protocols (>95%) and low rates of missing/unusable data (1.5%-11%). Qualitative results show that trust, training, communication, and supervision are key and that LHR report feeling empowered by their role. LHR training included various content areas over several weeks with special attention to LHR and participant safety. Training and supervision from both the academic researchers and the staff at the community-based organizations were necessary and had to be well-coordinated., Conclusions: Carefully selected, trained, and supervised LHRs can collect sophisticated data for community-based clinical and translational research., Competing Interests: Outside of the current work, Dr Orfeu M. Buxton discloses that he received subcontract grants to Penn State from Proactive Life (formerly Mobile Sleep Technologies), doing business as SleepSpace (National Science Foundation grant #1622766 and NIH/National Institute on Aging Small Business Innovation Research Program R43AG056250, R44 AG056250), received honoraria/travel support for lectures from Boston University, Boston College, Tufts School of Dental Medicine, New York University, University of Miami, University of South Florida, University of Utah, University of Arizona, Harvard Chan School of Public Health, Eric H. Angle Society of Orthodontists, and Allstate, consulting fees for SleepNumber, and received an honorarium from the National Sleep Foundation for his role as the Editor in Chief of the journal Sleep Health. All other authors have no competing interests to declare., (© The Author(s) 2023.)

Background: Early feeding practices have a great impact on the growth and development of infants, and the health of mothers. Maternal emotional regulation (ER) is closely related to infant feeding practices. Exploring the relationship between ER strategy and feeding practice can inform early exclusive breastfeeding (EBF) interventions., Methods: Using baseline survey of a longitudinal study, 965 mothers in Chongqing municipality, Guangzhou city, and Huizhou city were enrolled. At baseline, the study used self-administrated questionnaires to investigate the socio-demographic characteristics, maternal ER strategies and feeding practice within 72 h of delivery. Chi-square test and logistic regression were used to determine the associations of the mothers' ER and feeding practices within 72 h postpartum., Results: Among 965 participants, 27.8 % of mothers practiced EBF, and 69.5 % of mothers reported getting breastfeeding education from health providers. The average scores on the cognitive reappraisal and the expressive suppression of the ERQ were 29.95 ± 7.24 and 14.47 ± 5.16 respectively. Multivariable analysis showed women with expressive suppression were less likely to practice EBF (aOR = 0.96, 95%CI: 0.93-0.98, p = 0.002), while receiving breastfeeding education was positively associated with EBF (aOR = 1.52, 95%CI: 1.09-2.12, p = 0.013)., Limitations: Because the study started during the COVID-19 pandemic, the lock-down measures paused recruitments for quite some time reducing the enrollment of participation. The data we used was within 72 h postpartum, hence the period of time to study feeding practices was short., Conclusion: Mothers' ER strategy and breastfeeding education need to be addressed as part of interventions designed to improve EBF rates during the newborn period in China., Competing Interests: Conflict of interest The authors declare that they have no competing interests., (Copyright © 2023. Published by Elsevier B.V.)

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03−2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30−3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47−0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34−0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29−0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85−25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80−30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.

The introduction of fluids other than breast milk during the first few days of life or later neonatal period has been identified as a risk factor for suboptimal breastfeeding (BF) outcomes in numerous studies using varying study designs. However, the relationship between early introduction of fluids other than breast milk and BF outcomes has not been systematically assessed using only prospective studies that can establish temporality, which is critical for determining whether observed associations are causal. We conducted a systematic review and meta-analysis of prospective studies to assess if there is a difference in BF outcomes as a result of the introduction of: (a) milk-based prelacteals, (b) water-based prelacteals and (c) breast milk substitutes (BMS) between 4 days and 4 weeks postpartum. We searched PubMed, Lilacs, Web of Science and other repositories for original research investigating the relationship between early introduction of prelacteals and/or BMS and BF outcomes. Forty-eight studies met the inclusion criteria for the systematic review. Of the 39 prelacteal feeding studies, 27 had the prerequisite statistical information for inclusion in the meta-analysis. Findings from the meta-analysis showed a relationship between prelacteals and exclusive BF cessation (RR 1.44; 1.29-1.60) and any BF cessation (2.23; 1.63-3.06) among infants under 6 months old. Nine studies focusing on the introduction of BMS during the neonatal period identified this practice as a statistically significant risk factor for a shorter BF duration. Effective interventions are needed to prevent the introduction of unnecessary milk-based prelacteals and BMS during the perinatal and neonatal periods to improve BF outcomes., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The objective of this systematic review was to identify multifactorial risk factors for self-reported insufficient milk (SRIM) and delayed onset of lactation (DOL). The review protocol was registered a priori in PROSPERO (ID# CDR42021240413). Of the 120 studies included (98 on SRIM, 18 on DOL, and 4 both), 37 (31%) studies were conducted in North America, followed by 26 (21.6%) in Europe, 25 (21%) in East Asia, and Pacific, 15 (12.5%) in Latin America and the Caribbean, 7 (6%) in the Middle East and North Africa, 5 (4%) in South Asia, 3 (2.5%) in Sub-Saharan Africa, and 2 (1.7%) included multiple countries. A total of 79 studies were from high-income countries, 30 from upper-middle-income, 10 from low-middle-income countries, and one study was conducted in a high-income and an upper-middle-income country. Findings indicated that DOL increased the risk of SRIM. Protective factors identified for DOL and SRIM were hospital practices, such as timely breastfeeding (BF) initiation, avoiding in-hospital commercial milk formula supplementation, and BF counselling/support. By contrast, maternal overweight/obesity, caesarean section, and poor maternal physical and mental health were risk factors for DOL and SRIM. SRIM was associated with primiparity, the mother's interpretation of the baby's fussiness or crying, and low maternal BF self-efficacy. Biomedical factors including epidural anaesthesia and prolonged stage II labour were associated with DOL. Thus, to protect against SRIM and DOL it is key to prevent unnecessary caesarean sections, implement the Baby-Friendly Ten Steps at maternity facilities, and provide BF counselling that includes baby behaviours., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Caregivers are often concerned about baby behaviours. Without adequate counselling, parental response can lead to altering infant feeding and jeopardizing breastfeeding. We conducted a systematic review to assess the evidence about the influence of baby behaviours perceived as problematic (crying, sleep waking and posseting) on infant feeding decisions during the first 6 months of life (self-reported milk insufficiency, breastfeeding duration and introduction of formula). The review focused on quantitative studies published in English, Portuguese or Spanish without date restriction. The search was designed with the support of a medical librarian and conducted in seven databases. Data were managed in Covidence and risk of bias was assessed through the Johanna Briggs Institute critical appraisal checklists. Synthesis of the literature was guided by a conceptual model of the impact of baby behaviours on caregivers feeding practices. We retrieved and reviewed 4312 titles/abstracts and selected 22 for review; 10 were purely descriptive and 12 were cross-sectional, prospective and quasi-experimental studies. Although studies from diverse regions were included in the review, more than half were from high-income countries. All studies reported that baby behaviours affect feeding decisions, the most common baby behaviours studied were crying and fussiness, and the studies suggested relationships with lactation problems and reports of milk insufficiency, maternal breastfeeding confidence, breastfeeding duration and discontinuation, and introduction of formula. There are many factors that lead to perceiving baby behaviours as problematic and there is a need to provide anticipatory guidance to parents and caregivers, starting in pregnancy and counselling through well-trained health providers., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Objectives: We explored associations between night eating and health outcomes in Latinos with type 2 diabetes., Methods: Participants (n = 85) completed surveys, were measured for anthropometrics, provided blood samples, and wore Holter monitors for 24 hours to assess heart rate variability., Results: Participant mean age was 60.0 years, hemoglobin A1c was 8.7%, most preferred Spanish (92%), and had less than a high school education (76%). Compared with their counterparts who denied night eating, night eaters had lower heart rate variability in the low (Cohen's d = -0.55; P = 0.04) and very-low-frequency bands (d = -0.54, P = 0.05), and reported more emotional eating (d = 0.52, P = 0.04), and poorer sleep quality (Cohen's h = 0.64). They did not differ on beverage intake or depressive symptoms. In regression that included depressive symptoms, associations between night eating and outcomes became nonsignificant., Conclusions and Implications: Night eaters demonstrated worse health outcomes. If results are replicated, nutrition education for this population might focus on night eating., (Published by Elsevier Inc.)

Background: The United Nations Children's Fund (UNICEF) Community Infant and Young Child Feeding Counselling Package (C-IYCF CP) is used globally for infant and young child feeding (IYCF) counseling. With the C-IYCF CP last updated 8 y ago, mapping existing nurturing care content, identifying gaps, and documenting current country-level changes offers a unique opportunity to guide recommendations to strengthen the nurturing care content of this package., Objectives: The primary study aims were to: 1 ) identify and map existing nurturing care content within UNICEF's C-IYCF CP, 2 ) identify gaps related to nurturing care or feeding elements within the C-IYCF CP, 3 ) identify country-level nurturing care adaptations to the C-IYCF CP, and 4 ) identify best practices and lessons learned from country adaptations that can be recommended for inclusion in the C-IYCF CP., Methods: The assessment included 4 phases: 1 ) conduct an iterative process to identify and map nurturing care elements within the C-IYCF CP using a codebook explicitly developed for this assessment; 2 ) identify gaps in the C-IYCF CP; 3 ) apply the codebook to IYCF packages from 11 countries, revise, then finalize the codebook; and 4 ) identify and interview key informants from 4 countries whose IYCF packages had the most comprehensive nurturing care content plus 1 country where health care professionals make routine mother-child home visits., Results: The C-IYCF CP contained limited nurturing care content, especially around safety/security and early learning. All 5 countries interviewed had systematically identified and included priority nurturing care content in each package, yet content level varied. Two countries were also incorporating information technology into the training and delivery of the C-IYCF CP., Conclusions: Existing country-level best practices can address nurturing care elements missing from UNICEF's C-IYCF CP. Sharing these practices can allow countries to make context-driven, evidence-informed decisions on the nurturing care content to prioritize., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Socio-economic inequities can strongly influence suboptimal infant feeding outcomes. Factors such as lack of knowledge about breastfeeding, low family income, low educational attainment, social and economic status, cultural norms and ethnicity may negatively affect success with offering breastfeeding following a responsive feeding approach (ie. responsive breastfeeding). Such inequities can indeed shorten breastfeeding duration, and negatively affect behavioral and cognitive infant outcomes. In China, there is a dearth of studies focusing on breastfeeding from the responsive and health equity perspective., Objective: The aim of this article is to present a protocol of an ongoing longitudinal cohort study investigating factors associated with responsive breastfeeding behaviors, and the child's behavioral and cognitive development from birth to12 months post-partum in five centers in China. The study seeks to identify breastfeeding barriers and facilitators from a health equity perspective., Methods: We are enrolling 700 women and their singleton full term infants in Chongqing, Huizhou and Guangzhou urban and rural areas. The study questionnaires will be administrated within 72 h, 30 days, 3, 6, 9, and 12 months post-partum during the baby's vaccination visits. We will investigate the difference between urban and rural areas sociodemographic characteristics, breastfeeding knowledge, attitudes and practice, postnatal depression, maternal emotion regulation and parenting stress, and anthropometric and cognitive development indicators of the infants at each time-point., Conclusion: Our article illustrates how a cohort study can be designed to understand the barriers and facilitators of responsive breastfeeding taking equity principles into account to help promote infants' growth and development in China.

Background: In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates?, Methods: The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies., Results: We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and  interpersonal level (n = 3)., Conclusions: Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended  to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.

Responsive feeding (RF) has been recognized as necessary to prevent all forms of malnutrition including stunting and childhood obesity. Specific RF guidelines have been developed, but it is unclear how RF behaviours can be monitored systematically. Therefore, developing valid and reliable abbreviated and pragmatic RF scales is an important global priority. This is challenging, as RF is a construct with multiple dimensions including recognizing and responding to hunger and satiety cues, providing a nurturing environment during feeding episodes, and understanding how feeding needs evolve as a function of the developmental stage of the young child. Further, RF is embedded within the responsive parenting framework that in addition to RF includes sleep, soothing and play routines and the interconnections between them. A recent pioneer study conducted in a rural area of Cambodia validated an 8-item RF scale through direct feeding observations of 6- to 23-month-old infants at home, as part of two cross-sectional surveys conducted before and after a complementary feeding intervention. It is important for similar research to be conducted elsewhere to find out if it is possible or not to develop a core RF scale that is valid and reliable and that has adequate specificity and sensitivity for application in community studies and population surveys globally. As highlighted in this article, different definitions of RF have been used in the field; thus, it is important to reach consensus on a single definition to help move this research area forward., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account., (Copyright © American Society for Nutrition 2019.)

Dietary guidelines provide advice on what to eat to different subsets of the population but often do not take into account the "how" to eat. Responsive feeding is a key dimension of responsive parenting involving reciprocity between the child and caregiver during the feeding process and is characterized by caregiver guidance and recognition of the child's cues of hunger and satiety. Evidence indicates that providing responsive feeding guidance to mothers on how to recognize and respond appropriately to children's hunger and satiety cues can lead to improved feeding practices and weight status and developmental outcomes among infants and young children. In addition, early and nurturing exposures to foods with different tastes and textures and positive role modelling help children to learn to eat healthy foods. The importance of improving caregiver's responsive feeding behaviours to ensure the adequate introduction of complementary foods is becoming increasing recognized, but responsive feeding principles have not been taken into account in a comprehensive way in the development of dietary guidelines. The incorporation of all responsive feeding principles into dietary guidelines has a strong potential to enhance their impact on early childhood development outcomes for infants and young children but will require adaptation to the different contexts across countries to ensure that they are culturally sensitive and grounded in a deep understanding of the types of foods and other resources available to diverse communities., (© 2019 John Wiley & Sons Ltd.)

Background: Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved., Objective: We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association., Methods: HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects., Results: The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation., Conclusions: Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096., (Copyright © American Society for Nutrition 2019.)

Objective: Determine the impact of a 2-way text messaging intervention on time to contact between participants and their breastfeeding peer counselors (BFPCs) and on exclusive breastfeeding (EBF) status at 2 weeks and 3 months postpartum., Design: Multisite, single-blind, randomized, controlled trial., Setting: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) BFPC program., Participants: Low-income women (n = 174) participating in the WIC BFPC program., Intervention: The control group received the standard of care WIC Loving Support BFPC program. The intervention group received standard of care plus the text messaging intervention., Main Outcome Measures: Time to contact with BFPC and EBF status., Analysis: The 2-sample t test or χ 2 test assessed whether an association existed between study variables and each outcome. Multivariable ordinal and binary logistic regression assessed the impact of the intervention on time to contact and EBF status., Results: Lactation Advice Through Texting Can Help had a significant impact on early contact between participants and BFPCs (odds ratio = 2.93; 95% confidence interval, 1.35-6.37) but did not have a significant impact on EBF (odds ratio = 1.26; 95% confidence interval, 0.54-2.66)., Conclusions and Implications: Lactation Advice Through Texting Can Help has the potential to facilitate the work of BFPCs by shortening the time-to-first-contact with clients after giving birth. Research is needed to identify the level of breastfeeding support staff coverage that WIC clinics must have to meet the demand for services created by Lactation Advice Through Texting Can Help., (Copyright © 2017 Society for Nutrition Education and Behavior. All rights reserved.)

Objective: The study aims were to (i) identify determinants of Nutrition Facts Panel (NFP) use and (ii) describe the association between NFP use and dietary intake among Latinos with type 2 diabetes., Design: Baseline cross-sectional data from a clinical trial were used to assess the association between NFP use and dietary intake. Diet was measured using two methods: (i) a diet quality score (the Healthy Eating Index-2010) derived from a single 24 h recall and (ii) dietary pattern (exploratory factor analyses) from an FFQ. Multivariable logistic and non-parametric quantile regressions were conducted, as appropriate. Settings Hartford County, Connecticut, USA., Subjects: Latino adults (n 203), ≥21 years of age, with diagnosed type 2 diabetes, glycosylated Hb≥7 %, and without medical conditions limiting physical activity., Results: Participants' education level, diabetes-related knowledge and English speaking were positively associated with NFP use. At the higher percentiles of diet quality score, NFP use was significantly associated with higher diet quality. Similarly, NFP users were more likely to consume a 'healthy' dietary pattern (P=0·003) and less likely to consume a 'fried snack' pattern (P=0·048) compared with NFP non-users., Conclusions: The association between reported NFP use and diet quality was positive and significantly stronger among participants who reported consuming a healthier diet. While NFP use was associated with a healthier dietary pattern, not using NFP was associated with a less-healthy, fried snack pattern. Longitudinal studies are needed to understand whether improving NFP use could be an effective intervention to improve diet quality among Latinos with type 2 diabetes.

Background: Food insecurity (FI), diabetes prevalence, and poor diabetes outcomes all disproportionately affect Latinos in the United States. Heart rate variability (HRV) reflects autonomic tone, is associated with glycemic control, and predicts mortality in type 2 diabetes. It is unknown whether FI is related to HRV and, if so, whether glycemic control accounts for this association. Objective: This exploratory cross-sectional study examined FI and HRV among US Latinos with type 2 diabetes. Methods: Participants reported demographic characteristics, socioeconomic status, and FI, including the 6-item USDA food security module and a 1-item measure of diabetes-specific food security. Participants wore an ambulatory electrocardiogram monitor for 24 h. In the time domain, HRV was assessed with the SD of the R-R interval (SDNN). In the frequency domain, the power spectrum was integrated over 3 frequency bands-very low frequency (VLF), low frequency (LF), and high frequency (HF)-and then natural log transformed. Unadjusted ANOVA and ANCOVA adjusted for age, sex, glycated hemoglobin (HbA1c), and indicators of socioeconomic status compared food security groups on HRV. Results: Participants' mean ± SD age was 59.7 ± 10.9 y, and 73% were women. Of the 94 participants, 63 reported FI according to the USDA food security module and 46 reported FI according to the diabetes-specific measure. Mean ± SD HbA1c was 8.6% ± 1.7% and was marginally higher among those reporting diabetes-specific FI than those reporting diabetes-specific food security. Participants who reported diabetes-specific FI had lower SDNN, VLF, LF, and HF HRV with effect sizes in the small-to-medium range. Differences remained significant even after controlling for age, sex, socioeconomic hardship, and HbA1c. The 6-item USDA food security module was not associated with HRV. Conclusions: Diabetes-specific FI may be a unique risk factor for poor health outcomes among US Latinos. Efforts to address FI could benefit diabetes outcomes.

Background: Evidence increasingly indicates that poor sleep quality is a major public health concern. Household food insecurity (HFI) disproportionately affects Latinos and is a novel risk factor for poor sleep quality. Psychological distress may be a potential mechanism through which HFI affects sleep quality. Sleep, food insecurity, and distress are linked to type 2 diabetes mellitus., Objectives: We examined the relations between HFI, psychological distress, and sleep quality and tested whether psychological distress mediates the relation between HFI and sleep in people with diabetes mellitus., Methods: Latinos with type 2 diabetes mellitus (n = 121) who completed baseline assessments for the CALMS-D (Community Health Workers Assisting Latinos Manage Stress and Diabetes) stress management intervention trial completed the US Household Food Security Survey, and measures of depressive symptoms [Personal Health Questionnaire Depression Scale (PHQ-8)], anxiety symptoms [Patient-Reported Outcomes Measurement Information System (PROMIS)-short], diabetes distress [Problem Areas in Diabetes Questionnaire (PAID-5)], and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Psychological distress was operationalized with the PHQ-8, PROMIS-short, and PAID-5 scales. We used unadjusted and adjusted indirect effect tests with bias-corrected bootstrapped 95% CIs on 10,000 samples to test both relations between variables and potential mediation., Results: Mean age was 61 y, 74% were women, and 67% were food insecure. Experiencing HFI was associated with both greater psychological distress and worse sleep quality (P < 0.05). Depressive symptoms (adjusted R 2 : 2.22, 95% CI: 1.27, 3.42), anxiety symptoms (adjusted R 2 : 1.70, 95% CI: 0.87, 2.85), and diabetes mellitus distress (adjusted R 2 : 0.60, 95% CI: 0.11, 1.32) each mediated the relation between HFI and worse sleep quality with and without adjustment for age, education, income, marital status, and employment status., Conclusions: Household food insecurity is a common and potent household stressor that is associated with suboptimal sleep quality through psychological distress. Efforts to improve food security and decrease psychological distress may yield improved sleep in this high-risk population. The CALMS-D stress management trial was registered at clinicaltrials.gov as NCT01578096., Competing Interests: 2Author disclosures: A Bermúdez-Millán, R Pérez-Escamilla, S Segura-Pérez, G Damio, J Chhabra, CY Osborn, and J Wagner, no conflicts of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of by the Connecticut Institute for Clinical and Translational Science (CICATS) at the University of Connecticut., (© 2016 American Society for Nutrition.)

Objective: To 1) describe the benefits, conditions, coverage, funding, goals, governance, and structure of well-established conditional cash transfer programs (CCTs) in Latin America and 2) identify their health and nutritional impacts among children under 5 years old., Methods: A realist review was conducted. CCTs were included if they met the following inclusion criteria: 1) current national-level program; 2) coverage of at least 50% of the target population; 3) continuous operation at scale for 10+ years; 4) clear description of structure, funding sources, and governance; 5) both health/nutrition- and education-related conditions for participation; and 6) available impact evaluation studies with health, development, and/or nutrition indicators among children under 5 years old. Three CCTs (one each in Brazil, Colombia, and Mexico) met the criteria., Results: There was consistent evidence that the three CCTs selected for review had positive impacts on child health and nutrition outcomes in their respective countries. In all three countries, the programs were scaled up and positive impacts were documented relatively quickly. All three programs had strong political support and clear and transparent governance structures, including accountability and social participation mechanisms, which might explain their success and sustainability., Conclusions: CCTs in Latin America have had a positive impact on child health and nutrition outcomes among the poorest families. A key challenge for the future is to reform these programs to help families move out of not only extreme poverty but all poverty in order to lead healthy and productive lives, as called for in the post-2105 Sustainable Development Goals.

The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term., (© 2016 John Wiley & Sons Ltd.)

Objective: Identify barriers and facilitators to improve prenatal fruit and vegetable (F&V) intake among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible Latinas using the Health Action Process Approach framework., Design: Qualitative data were collected via audiotaped in-depth interviews as part of a larger study to design an intervention to increase prenatal F&V intake., Setting: Hartford, Connecticut., Participants: Forty-five WIC-eligible Latinas completed the study. Included women were: ≥ 18 years old; in 2nd or 3rd trimester; having a singleton pregnancy; overweight or obese (ie, pregravid body mass index ≥ 25); not on a restricted diet; nonsmokers., Phenomenon of Interest: Prenatal factors that promote and hinder F&V intake., Analysis: Transcripts were independently read and coded, and a consensus was reached about emerging themes., Results: Ten factors influenced prenatal F&V intake: social support, family structure, F&V access, F&V preferences, F&V knowledge, F&V health outcome expectations, self-efficacy, intentions, F&V action/coping planning strategies, and maternal health status., Conclusions and Implications: Social support from family/friends emerged as the primary distal factor driving prenatal F&V intake. Interventions designed to empower pregnant Latinas to gain the access, confidence, knowledge, and strategies necessary to consume more F&Vs must consider strengthening support to achieve the desired outcome., (Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine the impact of an intervention led by community health workers (CHWs) on food label use and to assess whether food label use and diet quality mediate the intervention's impact on glycemic control., Methods: From 2006 to 2010, 203 Latinos (intervention group, n = 100; control group, n = 103) in Hartford County, Connecticut, with type 2 diabetes were randomized to an intervention that included 17 CHW-led home-based sessions over a 12-month period in addition to the standard of care available in both study arms. Data on food label use, diet quality, covariates, and glycated hemoglobin (HbA1c) were collected at baseline and at 3, 6, 12, and 18 months. Data were analyzed via mixed effects and multilevel structural equation modeling., Results: Food label use in the intervention (vs control) group was significantly higher at 3, 12, and 18 months (odds ratio = 2.99; 95% confidence interval = 1.69, 5.29). Food label use and diet quality were positive mediators of improved HbA1c levels., Conclusions: Culturally tailored interventions led by CHWs could increase food label use. Also, CHW-delivered food label education may lead to better diet quality and improve glycemic control among Latinos with type 2 diabetes.

Objective: Latinos with type 2 diabetes (T2D) face major healthcare access and disease management disparities. We examined the impact of the Diabetes Among Latinos Best Practices Trial (DIALBEST), a community health worker (CHW)-led structured intervention for improving glycemic control among Latinos with T2D., Research Design and Methods: A total of 211 adult Latinos with poorly controlled T2D were randomly assigned to a standard of healthcare (n = 106) or CHW (n = 105) group. The CHW intervention comprised 17 individual sessions delivered at home by CHWs over a 12-month period. Sessions addressed T2D complications, healthy lifestyles, nutrition, healthy food choices and diet for diabetes, blood glucose self-monitoring, and medication adherence. Demographic, socioeconomic, lifestyle, anthropometric, and biomarker (HbA1c, fasting blood glucose, and lipid profile) data were collected at baseline and 3, 6, 12, and 18 months (6 months postintervention). Groups were equivalent at baseline., Results: Participants had high HbA1c at baseline (mean 9.58% [81.2 mmol/mol]). Relative to participants in the control group, CHWs had a positive impact on net HbA1c improvements at 3 months (-0.42% [-4.62 mmol/mol]), 6 months (-0.47% [-5.10 mmol/mol]), 12 months (-0.57% [-6.18 mmol/mol]), and 18 months (-0.55% [-6.01 mmol/mol]). The overall repeated-measures group effect was statistically significant (mean difference -0.51% [-5.57 mmol/mol], 95% CI -0.83, -0.19% [-9.11, -2.03 mmol/mol], P = 0.002). CHWs had an overall significant effect on fasting glucose concentration that was more pronounced at the 12- and 18-month visits. There was no significant effect on blood lipid levels, hypertension, and weight., Conclusions: DIALBEST is an effective intervention for improving blood glucose control among Latinos with T2D., (© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)

Background: The Mondelēz International Foundation hosted a seven country Healthy Lifestyles Program Evaluation Workshop in Granada, Spain, 13-14 September 2013., Objective: To present the Workshop Evaluation Manual developed to support the work of the participants before, during and after the workshop., Methods: The manual presents a brief introduction to program evaluation, a section on the Program Impact Pathways (PIP) framework using a USA school-based healthy lifestyle education program as an example, and a section on how to select PIP-informed indicators of the programs' impact on healthy lifestyles. The manual was refined using feedback received from the users before, during, and after the workshop., Results: As illustrated in additional articles in this Supplement chronicling the workshop, all seven countries benefited from and were successful at using the PIP manual presented here to develop their own PIP analyses and identify their suite of indicators of the programs' impact on healthy lifestyles to improve the evaluation of their programs., Conclusion: The PIP analyses were central for systematically identifying strengths and weaknesses of each country's program, as well as the key program activities, processes and impact indicators that need to be monitored to improve them.

To characterize metabolic syndrome (MetS) prevalence and cardiometabolic risk, HbA1c, fasting plasma glucose (FPG), plasma lipids, blood pressure, BMI, and waist circumference were measured in 211 Latino adults with type 2 diabetes. Participants were obese (BMI=33.7±7.8 kg/m2) and had poor glycemic control (HbA1c=9.6±1.8 %; FPG=190±85 mg/dL), but normal LDL and HDL cholesterol concentrations (98±38 mg/dL, and 52±14 mg/dL, respectively). Relative to the lowest, participants in the highest quintile of plasma triglycierides had higher total cholesterol (23%; p&lt;.0001), FPG (47%; p&lt;.0001), systolic blood pressure (3%; p&lt;.05) and diastolic blood pressure (6%; p&lt;.05), and lower HDL cholesterol (23%; p&lt;.01). Comparable relationships were observed in an age-adjusted regression model. Framingham risk was equivalent to 9.4±6.4% and 12.2±9.6% 10-year CHD risk in men and women, respectively (p&lt;.05). Cardiometabolic risk in this population is associated with a high prevalence of the MetS despite the relatively low cholesterol concentrations. Triglyceride screening may help identify individuals at higher risk.

Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness. Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor for experiencing enabling factor (OR = 1.46; 95% CI = 1.17-1.82), medication access (OR = 1.26; 95 CI% = 1.06-1.50), and forgetfulness (OR = 1.22; 95 CI% = 1.04-1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers. Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance, and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D.

Objective: To document nutrient and food group serving intakes from food sources among Latina subgroups living in the same geographical area., Design: A cross-sectional study. Nutrient and food group serving intakes were assessed by means of a 24 h recall administered immediately after a prenatal survey., Setting: Hartford, CT, USA., Subjects: A total of 233 low-income pregnant Latinas. For analyses, Latinas were classified into two groups on the basis of self-reported ethnic identity: Puerto Ricans and non-Puerto Rican Latinas., Results: Puerto Rican Latinas were more likely than non-Puerto Rican Latinas to be more acculturated and to consume foods (i.e. processed meat, cheese, soft drinks) and higher levels of nutrients (i.e. fat, SFA, MUFA, trans fatty acids) that have been implicated in the development of chronic diseases. By contrast, non-Puerto Rican Latinas were more likely to consume foods (i.e. fruits, dark green/yellow vegetables, tomatoes, non-starchy vegetables) and higher levels of nutrients (i.e. fibre, vegetable protein, folate, β-carotene) that promote health when compared with Puerto Rican Latinas., Conclusions: Findings suggest that acculturation may play a role in dietary intake. Clinicians and dietitians need to be aware of these differences to encourage healthy eating patterns among more acculturated pregnant Latina clients.

Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ≥21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.

This qualitative research project explores how poverty, the built environment, education, working conditions, health care access, food insecurity and perceived discrimination are experienced by Puerto Rican Latinas through the course of their lives. Five focus groups were conducted with the primary objective of documenting community experiences and perspectives regarding: 1) stress, including perceived discrimination based on race/ethnicity (racism); 2) the impact of stress on Puerto Rican women of reproductive age, their families, and/or their community; and 3) stressors that affect maternal health. Focus groups were conducted in English and Spanish in the two cities with the highest rates of premature birth and low infant birthweight in the state of Connecticut. Focus group findings indicate that participants perceived poverty, food insecurity, lack of access to quality education, and unsafe environments as significant life stressors affecting maternal and child health.

Latinas experience high rates of poverty, household food insecurity and prenatal depression. To date, only one USA study has examined the relationship between household food insecurity and prenatal depression, yet it focused primarily on non-Latina white and non-Latina black populations. Therefore, this study examined the independent association of household food insecurity with depressive symptoms among low-income pregnant Latinas. This cross-sectional study included 135 low income pregnant Latinas living in Hartford, Connecticut. Women were assessed at enrolment for household food security during pregnancy using an adapted and validated version of the US Household Food Security Survey Module. Prenatal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. A cut-off of ≥21 was used to indicate elevated levels of prenatal depressive symptoms (EPDS). Multivariate backwards stepwise logistic regression was used to identify risk factors for EPDS. Almost one third of participants had EPDS. Women who were food insecure were more likely to experience EPDS compared to food secure women (OR = 2.59; 95% CI = 1.03-6.52). Being primiparous, experiencing heartburn and reporting poor/fair health during pregnancy, as well as having a history of depression were also independent risk factors for experiencing EPDS. Findings from this study suggest the importance of assessing household food insecurity when evaluating depression risk among pregnant Latinas., (© 2010 Blackwell Publishing Ltd.)

Objective: To examine whether acculturation and social networks influence household food insecurity in an inner-city Puerto Rican community., Methods: A survey was administered to 200 low-income female Puerto Rican caregivers with at least 1 child 12-72 months old living in Hartford, CT. Food insecurity was measured with the Radimer/Cornell Hunger Scale. Multivariate logistic regression analyses were used to identify food insecurity risk factors., Results: Significant food insecurity risk factors included: being unemployed (odds ratio: 2.69), being single (2.34), being born in the United States (2.68), speaking only Spanish (3.15), planning to return to Puerto Rico (4.58), almost never/never attending Hispanic cultural events (6.85), and food stamps lasting less than a month (7.74)., Conclusions and Implications: Low levels of acculturation, lack of social networks, and poor food stamps management skills may influence household food insecurity., (Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine the independent association of food insecurity with type 2 diabetes (T2D), and to identify the T2D risk factors related to food insecurity among Latinas., Methods: Case-control study in a convenience sample of 201 Latinas (100 cases with T2D, 101 controls) aged 35-60 years and living in an urban setting. Self-reported data, including food insecurity, T2D status, depression symptoms, and socioeconomic, demographic, and lifestyle characteristics (food and alcohol intake, cigarette smoking, physical activity) were collected, and height, weight and waist circumference were measured. Separate multivariate logistic regression models were specified for T2D and food insecurity., Results: Participants with very low food security were 3.3 times more likely to have T2D (OR 3.33, 95% CI 1.34-8.23) independently of employment status, acculturation, waist circumference, and lifestyle characteristics. High waist circumference (>88cm) (OR 2.46, 95% CI 1.13-5.38) and being in the lowest quartile of physical activity level (OR 3.75, 95% CI 1.21-11.62) were also risk factors for T2D. Elevated depression symptoms and participation in the Supplemental Nutrition Assistance Program (SNAP) were positively related to low and very low food security after adjusting for waist circumference (P<.01); cigarette smoking was positively associated with very low food security, and nutrition knowledge was negatively related to low food security (P<.01)., Conclusions: These results highlight the need for interventions focusing on prevention of depression and food insecurity among Latinas with T2D.

This cross-sectional study assessed: (a) awareness and knowledge of federal dietary tools (MyPyramid, Food Guide Pyramid (FGP), and food labels (FL)), and (b) the influence of acculturation and state of residence on FGP knowledge (FGPK) indicators among low-income Latina WIC participants (N = 479) living in Connecticut, Ohio, Texas, and California. Participants were familiar with FGP but only 37% recognized MyPyramid. FGPK was highest for fruits (71%) and lowest for the 'breads and cereals' group (12%). Less than half (47%) used FL's when grocery shopping. Living in OH, was associated with the lowest FGPK. Multivariate analyses showed that more acculturated individuals living in CT/CA had better FGPK than participants living in TX and their less acculturated counterparts in CT/CA. The forthcoming revised federal dietary tools need to be adequately disseminated among Latinos, with special emphasis on those with lower acculturation levels, living in rapid emerging Latino communities or in the US-Mexico border.

The purpose of this study was to determine whether low plasma HDL and high C reactive protein (CRP) concentrations would further increase cardiovascular disease (CVD) risk in Latinos with poorly controlled type-2 diabetes, already at high risk for CVD. Subjects (n = 68) were grouped into High-HDL (≥ or 1.03 or 1.3 mmol/L) or Low-HDL (<1.03 or 1.3 mmol/L) for men and women, respectively. Following classification, risk factors for CVD including apolipoproteins, lipoprotein size and subfraction distribution were assesed. Similarly, participants were divided according to their CRP levels (≥ or < 3mg/L) and key inflammatory markers as well as leptin and adiponectin were analyzed. The Low-HDL group had higher concentrations of the atherogenic particles, large and medium VLDL and the smaller LDL subfractions compared to the High-HDL group (p<0.001). Consistently, VLDL diameter was larger and LDL diameter smaller in the Low HDL group (p<0.001). The High-CRP group had larger waist circumference (p<0.001) and body mass index (p<0.001) than the Low-CRP group. Leptin was also higher in the High- CRP group (p< 0.01). These data suggest that Latinos with type-2 diabetes having either Low-HDL or High-CRP concentrations are at a higher risk for atherosclerosis and CVD than their counterparts who have High-HDL or Low-CRP.

Proper nutrition during gestation is important to prevent adverse pregnancy outcomes. Eggs contain many important nutrients necessary for fetal development and human survival. Three focus groups were conducted with Latina women living in Connecticut to identify cultural beliefs toward egg consumption during pregnancy, traditional egg dishes, and methods of preparation. A cross-sectional study was then carried out with a sample of predominately Puerto Rican pregnant Latinas (N = 241) to identify the frequency of consumption of eggs and egg-containing dishes as well as methods of preparation using a tailored food frequency questionnaire modified for this population. Paired sample t-tests were used to examine if there were differences in weekly mean egg intake patterns between the year prior to the pregnancy and during pregnancy based on a Food Frequency Questionnaire. Women were categorized into eggs consumers and non-consumers if they consumed or did not consume eggs during the previous day based on 24-hour recall data. Independent-sample t-test and chi-square cross-tabulation analyses were conducted to examine the association between egg consumption and nutrient intake categories. Results showed that eggs and egg-containing traditional dishes are consumed by Latinas before and during pregnancy. Egg consumers had higher intakes of protein, fat, vitamin K, vitamin E, selenium, beta carotene, lutein and zeaxanthin, cholesterol, total polyunsaturated fatty acids, and docosahexaenoic acid. Eggs contribute significantly to the diet of pregnant Latinas.

The objectives of this study were to: 1) assessed the face validity of the 18-items US Household Food Security Scale Module (US HFSSM) among low-income pregnant Latinas and 2) adapt the US HFSSM to the target population. This study was conducted in the United States in Hartford, Connecticut where 40% of residents are of Latina descent. Three focus groups (N=14(total)) were held with pregnant and postpartum Latinas from April - June 2004 to assess the understanding and applicability (face validity) of the US HFSSM as well as adapt the US HFSSM based on their recommendations. This was followed by pre-testing (N=7) to make final adaptations to the US HFSSM. Overall, the items in the US HFSSM were clear and understandable to participants, but some questions sounded repetitive to them. Participants felt the questions were applicable to other pregnant Latinas in their community and shared food security related experiences and strategies. Participants recommendations led to key adaptations to the US HFSSM including reducing the scale to 15-items, wording statements as questions, including two time periods, replacing the term "balanced meals" with "healthy and varied", replacing the term "low cost foods" with "cheap foods" and including a definition of the term, and including a coping mechanism of avoiding running out of food. The adapted US HFSSM was found to have good face validity among pregnant Latinas and can be used to assess food insecurity among this vulnerable population.

Objective: To examine the associations of nutrition knowledge, food label use, and food intake patterns among Latinas with and without diagnosed diabetes., Design: This was a case-control study., Subjects/setting: A convenience sample of 201 (100 cases with diagnosed type 2 diabetes, 101 controls without diagnosed diabetes) nonpregnant, nonbreastfeeding Latinas without severe health conditions, aged 35 to 60 years were interviewed by bicultural interviewers. Diverse community-based recruitment methods were used., Statistical Analyses Performed: Independent samples t test, Mann-Whitney U, and chi(2) tests, and multivariate logistic regression were performed., Results: Food labels self-efficacy and stage of change, and average nutrition knowledge scores were similar between cases and controls (P>0.05). Within the diabetes group, nutrition knowledge was greater among those who had seen a registered dietitian or a diabetes educator (P=0.020). Cases reported consuming artificially sweetened desserts and beverages more frequently than controls (P<0.001). Pooled sample cross-sectional analyses showed that nutrition knowledge was positively related to food label use, which in turn was related to a more healthful food intake pattern (P<0.05). After adjusting for likely confounders, socioeconomic status (SES) was positively related to nutrition knowledge (P=0.001) and intakes of fruits, vegetables, and meats (P

Household food safety education is needed to minimize the risk of exposure to foodborne pathogens. The Latino population in the United States is growing at a fast rate and has become the largest minority group in this country. However, little research has been done to identify the food safety behavioral risks faced by Puerto Ricans. Ten in-depth household observations and a quantitative survey on food safety knowledge, attitudes, and behaviors (n = 100) were conducted to understand food-handling techniques among Puerto Rican caretakers of young children. This was followed by two focus groups (n = 12) to further characterize food safety knowledge, attitudes, and behaviors and the proper media channels for the delivery of food safety education. Even though 97% of survey participants reported washing their hands with soap and water before preparing foods, only 1 of the 10 participants in the household observations actually did it. About 60% of the household participants washed the cutting boards with soap and water compared with 89% of survey participants who claimed to do it. In the survey, 5% reported to know the meaning of cross-contamination, and 71% (n = 80) to use the same cutting board for meats and vegetables. Overall, 96% of survey participants did not use a thermometer to check if meats were cooked properly and only 10% defrosted their meats in the refrigerator. Statistically significant relationships (P < 0.05) were found between speaking English and knowing the meaning of cross-contamination and how to use a meat thermometer. Employed individuals and those with higher education were also more likely to be familiar with the term pasteurization. These results fully justify the delivery of culturally appropriate food safety education in this community.

To examine reasons for not breastfeeding, and to identify factors associated with ever breastfeeding among Puerto Rican women, a retrospective study was done using a convenience sample of 161 low-income Latino women with children younger than 6 years. Women were recruited from the Hispanic Health Council (43.5%), the Supplemental Nutrition Program for Women, Infants, and Children (29.8%), and other places (26.7%). Participants were interviewed using a pretested questionnaire specific to the target community. Most (73%) of the respondents chose to be interviewed in Spanish. Chi-square analyses were used to examine the bivariate association between ever breastfeeding and the independent variables. Multivariate logistic regression was conducted to estimate the independent association between acculturation, social capital, and breastfeeding. Women with more social capital were more likely (odds ratio = 2.25, 95% confidence interval, 1.02-4.95) to have breastfed the index child, suggesting that social capital is an important predictor of breastfeeding initiation in this community.