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Households with a low-income in rural places experience disproportionate levels of food insecurity. Further research is needed about the nuances in strategies that households with a low-income in rural areas apply to support food security nationally. This study aimed to understand the barriers and strategies that households with a low-income in rural areas experience to obtain a meal and support food security in the United States. We conducted a qualitative study with semi-structured interviews among 153 primary grocery shoppers with a low-income residing in rural counties. A majority of family’s ideal meals included animal-based protein, grains, and vegetables. Main themes included struggles to secure food and coping mechanisms. Ten categories included affordability, adequacy, accommodation, appetite, time, food source coordinating, food resource management, reduced quality, rationing for food, and exceptional desperation. These results can inform public health professionals’ efforts when partnering to alleviate food insecurity in rural areas.

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families&rsquo, perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.

In an effort to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for low-wealth rural communities, we applied discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: production, distribution, and infrastructure, healthy, organic, local food, behavioral health and education, sustainability, finance and investment, hunger relief, demand-side preferences, romanticized, community led transformations. Study findings reveal that of eight discourses, only three encompass the experiences of low-wealth rural residents. This aspirational food system may aggravate the lack of autonomy and powerlessness already experienced by low-wealth rural groups, perpetuate a sense of failure by groups who will be unable to reach the aspirational food vision, silence discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions, and leave out other policy-based solutions that address issues located within the food system. Further research might explore how to draw attention to silenced discourses on the needs and preferences of low-wealth rural populations to ensure that the policies and programs promoted by food system experts mitigate poor diets caused by food insecurity. Further research is needed to inform policies and programs to mitigate food insecurity in low-wealth rural populations.

Objective Rural black communities bear a disproportionate burden of obesity. To increase reach among underserved groups, community-based weight loss and maintenance interventions are crucial. Methods The Diabetes Prevention Program (DPP) was adapted for rural black adults of faith to create The Wholeness, Oneness, Righteousness, Deliverance (WORD) trial, a group-based, community health worker-delivered weight loss intervention. A Weight Loss Only arm (16 sessions) was compared with a Weight Loss + Maintenance arm (16 + 12 sessions) in a cluster randomized controlled trial of 31 churches (n = 440). Weight and related behaviors were assessed at 0, 6, 12, and 18 months. Results The WORD produced weight loss from baseline to 6 months (percentage body weight change -2.47 [-3.13 to -1.80]). Among those who lost 5% of their baseline weight, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance arm compared with control. Maintenance arm participants reported higher activity at 12 months. There were no between-arm differences at 18 months. Conclusions The WORD produced weight loss from baseline to 6 months on par with that produced by other DPP adaptations for black communities, including adaptations using health professionals. Weight regain was also consistent with that reported in prior literature. Continuing sessions as part of the church's mission may foster adoption of DPP-based weight loss programs.

© 2019 Wolters Kluwer Health, Inc. All rights reserved. Background: In patients with heart failure (HF), high dietary sodium intake is common and associated with HF symptoms, poor health-related quality of life (HRQOL), and high hospitalization rates. Purpose: The aims of this study were to examine the feasibility of a tailored dietary intervention with a practical tool (MyFitnessPal) and to obtain preliminary data about the effects on sodium intake, factors affecting sodium intake (knowledge, skills, experiences, confidence, perceived benefits and barriers, and depressive symptoms), HF symptoms, and HRQOL. Methods: A 6-session intervention was delivered to 11 participants. Paired t tests were used to compare the baseline outcomes with those at 3 months. Results Participants completed 98% of intervention sessions, and 91% used MyFitnessPal. Sodium intake was reduced, and factors affecting sodium intake, symptoms, and HRQOL were improved (all P

Objective To examine whether the addition of online motivational interviewing (MI) chats to a Web-based, group behavioral obesity treatment program augments weight loss outcomes relative to the Web-based weight control program alone. Methods Healthy individuals (N = 398, 24% minority) with overweight/obesity were randomized to a 36-session group Internet behavioral weight control treatment (BT) or the same group Internet treatment plus six individual MI chat sessions (BT + MI). Both conditions received weekly synchronous online chat group sessions for 6 months followed by 12 monthly group chats. Participants in both groups received identical behavioral lessons and individualized therapist feedback on progress toward meeting exercise and calorie goals. BT + MI also received six individual MI sessions delivered by a separate MI counselor via Web chat. Weight loss was measured at 6 and 18 months. Results There were no significant differences in weight loss between BT (−5.5 ± 6.0 kg) and BT + MI (−5.1 ± 6.3 kg) at 6 months or at 18 months (−3.3 ± 7.1 kg vs. −3.5 ± 7.7 kg for BT and BT + MI, respectively). Attendance at group chats did not differ between groups, nor did self-monitoring patterns, suggesting comparable engagement in the weight control program in both conditions. Conclusions Online MI chat sessions were not a viable strategy to enhance Web-based weight control treatment outcomes.

Purpose: There is minimal information regarding the Reach and Adoption of evidence-based weight loss maintenance interventions for African Americans of faith. Design: The WORD (Wholeness, Oneness, Righteousness, Deliverance) was an 18-month, cluster randomized trial designed to reduce and maintain weight loss in African American adults of faith. Participants received the Diabetes Prevention Program adapted core weight loss program for 6 months, and churches were subsequently randomized to 12-month maintenance treatment or control. All participants underwent body weight and associated behavioral and psychosocial assessments at baseline, 6, 12, and 18 months. The current article focuses on assessing Reach and Adoption at baseline and 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Setting: Lower Mississippi Delta. Participants: Thirty churches, 61 WORD Leaders (WLs), and 426 participants. Intervention: Group delivered by trained community members (WLs). Measures: Body mass index and percentage weight lost from baseline to 6-month follow-up were measured. Reach was assessed at participant, WL, and church levels through calculating participation rates and sociodemographics of each level. Adoption was assessed at church and WL levels. Analysis: Descriptive statistics summarized baseline characteristics of each level. Continuous and categorical end point comparisons were made. Results: Participants’ participation rate was 0.84 (n = 437 agreed to participate, n = 519 eligible invited to participate); they were predominantly female, employed, and had a mean age of 49.8. Dropouts by 6 months were younger, had differential marital status, and religious attendance compared with retained participants. Church participation rate was 0.63 (n = 30 enrolled, n = 48 eligible approached) and the majority reported ≤100 active members. The WL participation rate was 0.61 (n = 61 implemented intervention, n = 100 eligible approached); they were primarily female and aged 53.9 (mean). Conclusion: Recruitment, engagement, and delivery strategies employed by the WORD show promise of sustained engagement and adoption in other faith-based behavioral weight management programs for African Americans.

PURPOSE OF THE STUDY Lay health educators (LHEs) offer great promise for facilitating the translation of evidence-based health promotion programs to underserved areas; yet, there is little guidance on how to train LHEs to implement these programs, particularly in the crucial area of empirically validated obesity interventions. DESIGN AND METHODS This article describes experiences in recruiting, training, and retaining 20 LHEs who delivered a 12-month evidence-based behavioral lifestyle intervention (based on the Diabetes Prevention Program) in senior centers across a rural state. A mixed method approach was used which incorporated collecting the folllowing: quantitative data on sociodemographic characteristics of LHEs; process data related to training, recruitment, intervention implementation, and retention of LHEs; and a quantitative program evaluation questionnaire, which was supplemented by a qualitative program evaluation questionnaire. Descriptive statistics were calculated for quantitative data, and qualitative data were analyzed using content analysis. RESULTS The training program was well received, and the LHEs effectively recruited participants and implemented the lifestyle intervention in senior centers following a structured protocol. IMPLICATIONS The methods used in this study produced excellent long-term retention of LHEs and good adherence to intervention protocol, and as such may provide a model that could be effective for others seeking to implement LHE-delivered health promotion programs.

Background Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults. Design An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training). Setting/participants Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010. Interventions A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators. Main outcome measures Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011. Results Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p Conclusions A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas. Trial registration This study is registered at Clinicaltrials.govNCT01377506.

Weight concern is a common and significant barrier to abstinence for many smokers. This quasi-experimental pilot study used multivariate logistic regression to examine the effects of offering a weight management treatment program on tobacco dependence treatment outcomes. Age, gender, ethnicity, educational level, nicotine dependence level, body mass index, and concern about weight gain were entered as factors/covariates to account for differences between groups. Offering a weight management program increased attendance at the first scheduled contact (88.1% vs. 71.6%; OR = 2.93; p = .029) and increased 6-month abstinence (21.4% vs. 10.1%; OR = 2.42; p = .052). With factors and covariates included in the multivariate models to account for group differences, those offered weight management were five times more likely to attend their first session (OR = 5.10; 95% CI 1.53–16.98; p = .008) and three times more likely to be abstinent 6 months after tobacco treatment (OR = 2.98; 95% CI = 1.09–8.17; p = .033). Proactively informing weight-concerned, overweight/obese smokers about the availability of a weight management program as an incentive for completing treatment for tobacco dependence may improve tobacco treatment outcomes. (Am J Addict 2010;00:1–8)

Most faith-based obesity intervention research has been conducted in African-American Protestant churches. However, Catholic communities might also benefit from a faith-tailored approach. Overweight Catholic individuals ( n = 34, 71% female) were randomized to a Catholic-tailored or standard behavioral 16-week group weight control program. Both conditions experienced significant weight losses (Catholic-tailored: -8.1 + 4.1%, Standard: -7.9 + 4.2%); however, treatment satisfaction was significantly greater in the Catholic-tailored program. The Catholic-tailored program experienced trends for greater attendance, more completed self-monitoring journals, and smaller weight regain six months post-treatment than the standard program. Catholic-tailored programs may represent a feasible, culturally acceptable and effective approach to weight loss/maintenance in this faith community.

Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. This study examined whether demographic factors of the store neighborhood or store size have an impact on the availability and price of healthy foods in sample of grocery stores and supermarkets. The Nutrition Environment Measures Study-Store (NEMS-S) instrument, a standardized observational survey, was utilized to evaluate food stores (N = 42) in a multi-site (Vermont and Arkansas) study in 2008. Census data associated with store census tract (median household income and proportion African-American) were used to characterize store neighborhood and number of cash registers was used to quantify store size. Median household income was significantly associated with the NEMS healthy food availability score (r = 0.36, P0.05); neither racial composition (r = -0.23, P = 0.14) nor store size (r = 0.27, P = 0.09) were significantly related to the Availability score. Larger store size (r = 0.40, P0.01) was significantly associated with the NEMS-S Price scores, indicating more favorable prices for healthier items; neither racial composition nor median household income were significantly related to the Price score (P's0.05). Even among supermarkets, healthier foods are less available in certain neighborhoods, although, when available, the quality of healthier options did not differ, suggesting that targeting availability may offer promise for policy initiatives. Furthermore, increasing access to larger stores that can offer lower prices for healthier foods may provide another avenue for enhancing food environments to lower disease risk.

Objective: To provide the specific weight loss outcomes for African-American, Hispanic, and white men and women in the lifestyle and metformin treatment arms of the Diabetes Prevention Program (DPP) by race-gender group to facilitate researchers translating similar interventions to minority populations, as well as provide realistic weight loss expectations for clinicians. Methods and Procedures: Secondary analyses of weight loss of 2,921 overweight participants (22% black; 17% Hispanic; 61% white; and 68% women) with impaired glucose tolerance randomized in the DPP to intensive lifestyle modification, metformin or placebo. Data over a 30-month period are examined for comparability across treatment arms by race and gender. Results: Within lifestyle treatment, all race-gender groups lost comparable amounts of weight with the exception of black women who exhibited significantly smaller weight losses (P < 0.01). For example, at 12 months, weight losses for white men (−8.4%), white women (−8.1%), Hispanic men (−7.8%), Hispanic women (−7.1%), and black men (−7.1%) were similar and significantly higher than black women (−4.5%). In contrast, within metformin treatment, all race-gender groups including black women lost similar amounts of weight. Race-gender specific mean weight loss data are provided by treatment arm for each follow-up period. Discussion: Diminished weight losses were apparent among black women in comparison with other race-gender groups in a lifestyle intervention but not metformin, underscoring the critical nature of examining sociocultural and environmental contributors to successful lifestyle intervention for black women.

Objective: To characterize sugar-sweetened beverage intake of college students. Research Methods and Procedures: Undergraduates in an urban southern community campus were surveyed anonymously about sugared beverage consumption (soda, fruit drinks, energy drinks, sports drinks, sweet ice tea) in the past month. Results: Two hundred sixty-five undergraduates responded (66% women, 46% minority, 100% of volunteers solicited). Most students (95%) reported sugared beverage intake in the past month, and 65% reported daily intake. Men were more likely than women to report daily intake (74% vs. 61%, p = 0.035). Soda was the most common sugar-sweetened beverage. Black undergraduates reported higher sugared beverage intake than whites (p = 0.02), with 91% of blacks reporting sugar-sweetened fruit drink intake in the past month and 50% reporting daily consumption. Mean estimated caloric intake from combined types of sugar-sweetened beverages was significantly higher among black students than whites, 796 ± 941 vs. 397 ± 396 kcal/d (p = 0.0003); the primary source of sugar-sweetened beverage calories among blacks was sugared fruit drinks (556 ± 918 kcal/d). Younger undergraduates reported significantly higher intake than older students (p = 0.025). Discussion: Self-reported sugar-sweetened beverage consumption among undergraduates is substantial and likely contributes considerable non-nutritive calories, which may contribute to weight gain. Black undergraduates may be particularly vulnerable due to higher sugared beverage intake. Obesity prevention interventions targeting reductions in sugar-sweetened beverages in this population merit consideration.

Objective Older adults in the U.S. have high rates of obesity. Despite the demonstrated efficacy of lifestyle interventions among older adults, lifestyle interventions are not widely implemented in community settings. Program delivery by lay health educators (LHEs) might support greater dissemination because of lower delivery cost and greater accessibility. We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program (DPP) evidence-based lifestyle intervention for older adults in Arkansas senior centers. Methods This examination of costs used data from a cluster randomized control trial (conducted 2008–2010) in which 7 senior centers (116 participants) were randomized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention. We compiled direct lifestyle intervention implementation costs, including training, recruitment, materials, and ongoing intervention implementation support. Weight loss data (at 4-month follow-up) were collected from participants. Results Participant weight loss averaged 3.7 kg at 4-months. The total estimated cost to implement the lifestyle intervention is $2731 per senior center, or $165 per participant. The implementation cost per kilogram lost is $45. Conclusions A LHE-delivered DPP translation in senior centers is effective in achieving weight loss at low cost and offers promise for the dissemination of this evidence-based intervention.

Objective To determine the association between clustering of adverse health behaviors (cigarette smoking, alcohol intake, and sedentarism) and serum carotenoids in a representative sample of white, Black, and Hispanic Americans. Methods Data (n=6,218) from the Third US National Health and Nutrition Examination Survey were utilized for this investigation. Adjusted gender-specific linear regression analyses were used. Results Increase in clustering of adverse health behaviors was associated with decreased serum concentrations of a-carotene, b-carotene, bcryptoxanthine, and luteine/zeaxanthene in the 3 racial/ethnic groups (P Conclusion Persons with multiple adverse health behaviors should be advised to increase fruit and vegetable consumption, as primary sources of chemopreventive antioxidants.

High-protein diets have recently been proposed as a “new” strategy for successful weight loss. However, variations of these diets have been popular since the 1960s. High-protein diets typically offer wide latitude in protein food choices, are restrictive in other food choices (mainly carbohydrates), and provide structured eating plans. They also often promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning as mechanisms of action for weight loss. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. In high-protein diets, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression. Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. Promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked for a variety of reasons for most individuals. High-protein diets are not recommended because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs. Individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall.

Objective: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension–diabetes comorbidity (HDC). Research Methods and Procedures: Data (n = 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cut-points of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. Results: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was ∼73% and ∼61%, respectively. The corresponding values for black and Hispanic women were ∼115% and ∼125%, respectively. Conclusions: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.

The aim of this study was to evaluate the association of abdominal adiposity assessed by waist circumference (WC) with clustering of multiple metabolic syndromes (MMS) in White, Black and Hispanic Americans. MMS was defined as the occurrence of two or more of either hypertension, type 2 diabetes mellitus, dyslipidemia, hypertriglyceridemia or hyperinsulinemia.The number of MMS and fasting insulin (a surrogate measure of MMS) were each used as dependent variables in gender-specific multiple linear regression models, adjusting for age, smoking and alcohol intake. The contribution of WC to interethnic differences in clustering of MMS and fasting insulin concentration was assessed in gender-specific linear regression models. The risk of MMS due to large waist was estimated by comparing odds ratio for men with WC/= 102 cm with those with WC102, and women with WC/= 88 cm with women with WC88 cm in the logistic regression model adjusting for age, smoking and alcohol intake.WC was positively and independently associated with clustering of MMS and increased fasting insulin concentration adjusting for age, smoking and alcohol intake in the three ethnic groups (p0.01). Black ethnicity was associated with clustering of MMS and fasting insulin concentration (p0.01). Hispanic ethnicity was also associated with clustering of MMS in men and associated with fasting insulin concentration in both men and women (p0.01). In both men and women, the risk of MMS clustering was strongly associated with increased WC in all ethnic groups independent of BMI.WC appears to be a marker for multiple metabolic syndromes in these ethnic groups. The results of this investigation lend support to the view that waist measurement should be considered as a clinical variable for assessing the risk of cardiovascular diseases.

Objectives: To determine whether a cognitive intervention delivered by lay health educators (LHEs) in senior centers was effective in improving cognition in obese older adults. Methods: This cluster randomized trial was conducted in 16 senior centers from which 228 senior adults were recruited. The centers were randomized to either the cognitive intervention or a control, weight-loss intervention. The primary outcome variable, cognitive function, was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results: Analyses of RBANS indices as continuous variables did not indicate significant differences between arms. However, after adjusting for baseline delayed memory, gender, and baseline body mass index, seniors in the cognitive intervention arm had a 2.7 times higher odds of a reliable improvement (clinically significant) in delayed memory from baseline as compared to those in the control intervention (95% CI, 1.3-5.6, p = .011). The intervention effect was not significant for the proportion showing reliable improvement in immediate memory or in attention. Attendance at the 12-session program was high with an average of 83% (67%-92%) sessions attended and 87% of participants in the cognitive arm indicating they would recommend the program. Discussion: Cognitive interventions can be effectively delivered in the community by LHEs.

The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week adaptation of the Diabetes Prevention Program Lifestyle Balance intervention augmented with stress management strategies (Lifestyle + Stress) or Lifestyle Alone. A trend toward greater percentage of baseline weight loss at 3-month data collection was observed in Lifestyle + Stress (−2.7 ± 3.6%) compared with Lifestyle Alone (−1.4 ± 2.3%; p = .17) and a greater reduction in salivary cortisol (Lifestyle + Stress: −0.2461 ± 0.3985 ng/mL; Lifestyle Alone: −0.0002 ± 0.6275 ng/mL; p = .20). These promising results suggest that augmenting a behavioral weight control intervention with stress management components may be beneficial for overweight/obese AA women with moderate to high stress levels and merit further investigation with an adequately powered trial.

Introduction Older adults could benefit from public health interventions that address the health conditions they face. However, translation of evidence-based interventions into the community has been slow. We implemented 2 evidence-based interventions delivered by lay health educators in Arkansas senior centers from 2008 to 2011: a behavioral weight loss intervention and a memory improvement intervention. The objective of this study was to measure the ability of these programs to reach and serve the growing population of older Americans. We report on differences in program enrollment by age, sex, race, and ethnicity and suggest how our approach to calculating the reach of the 2 interventions can guide future research and program development. Methods We defined the reach of the 2 interventions as the proportion of people who needed the intervention and responded to initial recruitment efforts but who did not enroll compared with the proportion of people who needed the intervention and actually enrolled in the program. To calculate these proportions, we used Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance framework formulas. We defined need as the prevalence of obesity (body mass index in kg/m2 ≥30) and the level of concern about memory problems among older adults aged 60 years or older. Our target population was 2,198 people aged 60 years or older who attend 15 senior centers in Arkansas. Results More than half of our target population responded to recruitment efforts for the behavioral weight loss intervention (61.9%) and for the memory improvement intervention (58.1%), yielding an overall response rate of 59.7%. More than one-third (35.6%) of the target population enrolled in the behavioral weight loss intervention, and 22.8% enrolled in the memory improvement intervention, for an overall reach for the 2 programs of 27.9%. Conclusion The reach of 2 evidence-based interventions designed for older adults that targeted specific health conditions and that were delivered in senior centers by community members was high. Our approach to calculating reach in applied settings can guide future research and program development.

We defined the reach of the 2 interventions as the proportion of people who needed the intervention and responded to initial recruitment efforts but who did not enroll compared with the proportion of people who needed the intervention and actually enrolled in the program. To calculate these proportions, we used Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance framework formulas. We defined need as the prevalence of obesity (body mass index in kg/m ≥30) and the level of concern about memory problems among older adults aged 60 years or older. Our target population was 2,198 people aged 60 years or older who attend 15 senior centers in Arkansas. Results More than half of our target population responded to recruitment efforts for the behavioral weight loss intervention (61.9%) and for the memory improvement intervention (58.1%), yielding an overall response rate of 59.7%. More than one-third (35.6%) of the target population enrolled in the behavioral weight loss intervention, and 22.8% enrolled in the memory improvement intervention, for an overall reach for the 2 programs of 27.9%. Conclusion The reach of 2 evidence-based interventions designed for older adults that targeted specific health conditions and that were delivered in senior centers by community members was high. Our approach to calculating reach in applied settings can guide future research and program development.

Collaboratively, the nutritional health problems of the Lower Mississippi Delta (LMD) region were examined and opportunities identified for conducting research interventions. To combat the nutritional health problems in the LMD, community residents yielded to a more comprehensive and participatory approach known as community-based participatory research (CBPR). Community residents partnered with academic researchers and other organizational entities to improve the overall quality of diet and health in their respective communities using CBPR. The collaborative work in the LMD focused on interventions conducted in each of three specific communities across three states: Marvell, Arkansas (Marvell NIRI), and its surrounding public school district; Franklin Parish in Louisiana (Franklin NIRI); and the city of Hollandale, Mississippi (Hollandale NIRI). This paper examined some of the research interventions conducted in Franklin, Hollandale, and Marvell NIRI respectively, how leadership emerged from each of these communities, and lessons learned as a result of the CBPR model.

The longstanding high burden of obesity in African-American women and the more recent, steeper than average rise in obesity prevalence among African-American children constitute a mandate for an increased focus on obesity prevention and treatment research in African-American communities. The African-American Collaborative Obesity Research Network (AACORN) was formed to stimulate and support greater participation in framing and implementing the obesity research agenda by investigators who have both social and cultural grounding in African-American life experiences and obesity-related scientific expertise. AACORN's examination of obesity research agenda issues began in 2003 in conjunction with the Think Tank on Enhancing Obesity Research at the National Heart, Lung, and Blood Institute (NHLBI). The assessment was subsequently expanded to take into account the overall NIH strategic plan for obesity research, literature reviews, and descriptions of ongoing studies. In identifying priorities, AACORN members considered the quality, quantity, focus, and contextual relevance of published research relevant to obesity prevention and treatment in African-American adults or children. Fifteen recommended research priorities are presented in five categories adapted from the NHLBI Think Tank proceedings: health effects, social and environmental context, prevention and treatment, research methods, and research training and funding. These recommendations from an African-American perspective build on and reinforce certain aspects of the NHLBI and overall NIH research agendas by providing more specific rationale and directions on areas for enhancement in the type of research being done or in the conceptualization and implementation of that research.

High sodium intake is associated with high levels of blood pressure, both among and within populations. However, there have been few intervention studies from Africa reporting blood pressure changes with dietary reduction of sodium. In this study, we tested the feasibility of achieving a reduction in dietary sodium intake in free-living individuals using a dietary intervention among 82 free-living normotensive adults in southwest Nigeria. The participants, 49 men (mean age 47.2 years) and 33 women (mean age 43.6 years), received dietary advice to reduce sodium intake and maintained the reduced sodium diet for a 2-week period. Blood pressure and 24-hour urinary excretion of sodium were measured at baseline and after two weeks on the reduced sodium diet. Baseline 24-hour urinary sodium excretion was 140.5 (SD 53.4) mmol/24 hours among men and 132.6 (SD 48.0) mmol/24 hours among women. Twenty-four hour urinary sodium excretion fell by 76.9 (95% Cl 59.7, 94.1) mmol/24 hours among men, and by 79.4 (95% Cl 59.4, 99.1) mmol/24 hours among women. On the low sodium diet, systolic blood pressure fell by 4.7 (95% CI 1.9, 7.4) mm Hg among men, and by 7.0 (95% CI 2.6, 11.4) mm Hg among women while diastolic blood pressure fell by 1.9 (95% CI -0.3, 4.1) mm Hg among men and by 1.6 (95% CI -1.8, 5.0) mm Hg among women. It is concluded that a significant reduction in sodium intake may be achievable in free-living individuals in this setting using a simple dietary intervention. The findings of this pilot study should encourage more sophisticated intervention studies (such as cross-over trials and double blind randomized clinical trials) in Africans for the elucidation of mechanisms and consequences of hypertension in Blacks.

Objective Measure relationships of locus of control and social support to diet changes in an intervention trial. Design Participants in the Polyp Prevention Trial (PPT) completed Multidimensional Health Locus of Control (MHLC) and Norbeck Social Support Questionnaires (NSSQ) and modified Block food frequency questionnaires. Data were collected at baseline and 1 year later. Subjects/setting A convenience sample of PPT intervention (N=68) and control (n=43) participants at 1 clinical center participated in this ancillary study. Main outcome measures Mean daily dietary intakes after 1 year were compared with baseline values. Intervention participants' scores for MHLC internal locus of control and NSSQ total functional network were correlated with diet changes. Statistical analyses performed Group percentages were compared using the Fisher exact test; means were compared by t test. Results Groups were comparable in demographics, baseline diet, and scores for internal locus of control and total functional network. Intervention group participants made greater diet changes than control participants in intake of fat (−27g vs −8g), fat as a percentage of kilocalories (−8% vs −2%), fiber as grams per 1,000 kcal (7g vs 0.3g), and daily fruit/vegetable servings (2.0 vs 0.2). Pearson correlations of diet changes with internal locus of control scores (all P >.05) were fat grams, r =0.031; fat as percentage of kilocalories, r =0.023; fiber grams per 1,000 kcal; r =0.230; and fruit/vegetable servings, r =0.186. Correlations with total functional network scores were: fat grams, r =0.022 (P>.05); fat as percentage of kilocalories, r =−0.108 ( P >.05); fiber grams per 1,000 kcal, r =0.276, P r =0.326, P Applications/Conclusions Intensive and skillful dietary intervention can succeed whether or not clients bring strong internal locus of control or social support to the diet change program. J Am Diet Assoc. 2001;101:203-208.

Summary: We report energy intake and selected nutrient intakes–protein, fat (total, saturated, and polyunsaturated), carbohydrate (total, starch, and sucrose), and cholesterol–for 1251 white children ages 6–19 years. The data were obtained, by means of a 24-h dietary recall, from children who were randomly selected from the North American populations studied by the Lipid Research Clinics Program. Females (N = 584) consumed about 2000 kcal daily, an intake that remained relatively constant throughout the age groups studied. Males (N = 667) had an energy intake of 2000 kcal/day during childhood that increased to over 3000 kcal/day in adolescence. Energy sources for both sexes were approximately 15% protein, 38% total fat, 15% saturated fat, 6% polyunsaturated fat, 48% total carbohydrate, 19% starch, and 11% sucrose; cholesterol intake averaged about 145 mg/1000 kcal. For both sexes, fat intake increased with age. Compared to females, males ingested greater amounts of cholesterol and total and saturated fat.

Protein-energy undernutrition has its most devastating consequences during growth. Postal somatic growth now appears to be regulated in large part by the somatomedins, a family of growth hormone-dependent peptide mitogens. This study, using growing rats as the model, was designed to determine the relationship between protein and energy intake and serum immunoreactive somatomedin-C. Four-week-old male Sprague-Dawley rats were fed ad libitum three levels of isoenergetic protein diets (5%, 10%, and 15% lactalbumin) at each of three levels of energy (ad libitum, 75% or 50% of ad libitum quantities). Dietary fat was held constant at 11.9% as cottonseed oil. At 5 weeks of age, serum somatomedin-C concentration was predominately influenced by the dietary protein and increased linearly as protein intake increased from 5% to 15%. at 6, 9, and 12 weeks of age, serum somatomedin-C concentration was influenced by both protein and energy intake, although protein intake appeared to be the more important variable. Serum somatomedin-C was highly correlated with both body weight (r = 0.84, P less than 0.001) and tail length (r = 0.74, P less than 0.01). These results indicate that measurement of immunoreactive somatomedin-C provides a valuable biochemical index of protein-energy nutriture.