Search

Background: Improving the diet of communities experiencing health inequities can be challenging given that multiple dietary components are low in quality. Mississippi Communities for Healthy Living was designed to test the comparative effectiveness of nutrition education using a single- versus multiple-message approach to improve the diet of adult residents in the Lower Mississippi Delta. Method: The single-message approach targeted discretionary calories while the multiple-message approach also targeted vegetables, fruits, whole grains, and lean protein. Delta food frequency questionnaires were used to measure participants' diet, while the Healthy Eating Index--2005 (HEI-2005) was used to generate diet quality scores. Generalized linear mixed model regression was used to test for significant time, treatment, and time × treatment interaction effects in HEI-2005 component and total score changes. Results: The majority of participants in the single- and multiple-message arms (n = 114 and 127, respectively) were female (88% and 96%, respectively), African American (90% and 98%, respectively), overweight or obese (92% and 87%, respectively), and 41 to 60 years of age (57% and 43%, respectively). Significant time effects were present for HEI-2005 total and component scores, with three exceptions--whole fruit, total grains, and saturated fat. Significant treatment effects were present for two components--total and whole fruit; scores were higher in the multiple-message approach arm as compared to the single-message approach arm across time points. No interaction effects were significant for any of the HEI-2005 scores. Conclusion: Focusing nutrition education on the discretionary calories component of the diet may be as effective as focusing on multiple components for improving diet quality.

Purpose/Objectives: The purpose of this study was to evaluate behaviors related to fruit and vegetable intake before and after implementation of a theory-based Farm to School pilot intervention in a rural school. Methods: Students in fifth grade at a rural elementary school were asked to complete pre- and post-test measures based on the Theory of Planned Behavior (TPB). A pilot Farm to School intervention was implemented and activities targeted students' beliefs, social norms, and self-efficacy regarding fruit and vegetables. Cafeteria promotions, taste testing, and class materials were included in the intervention. Wilcoxon signed ranks test was conducted to test for differences over time, and Kendall's tau correlation assessed relationships between reported access to fruits and vegetables at home and reported intakes of fruits and vegetables as well as preferences. Results: Demographics of the participants were representative of the school (48% female and 69% white) and entire district (50% female and 74% white). A total of 124 students participated, and significant differences were found between pre- and post-test means for students' beliefs scores (z = -2.183; p = 0.029). Significant correlations were found between reported intakes of fruits and vegetables and access to fruits and vegetables at post-test (t = 0.253; p = 0.001) as well as between social norms and access (t = 0.194; p = 0.011). Applications to Child Nutrition Professionals: Findings demonstrated potential for effective implementation of a theory-driven, school-based intervention in elementary school students to increase awareness of the importance of fruit and vegetable consumption in fifth graders at one school site.

Objective: To explore cultural perceptions of the MyPyramid key messages and identify factors that may impact adoption of these recommendations. Methods: Systematic content analysis of transcripts from in-depth, structured interviews with 23 adults, primarily African American females, residing in the Lower Mississippi Delta. Results: When asked to identify good reasons to follow the MyPyramid key messages, nonspecific references to improved health were most prevalent (n = 130); however, participants also acknowledged the importance of getting vitamins and nutrients (n = 81), and the impact food choices have on health conditions (n = 77) and organ systems (n = 65). Individual-level factors (n = 211), such as dislike for food items and tradition or customs, far outnumbered environmental-level factors (n = 48), such as cost and availability, as perceived reasons preventing community members from adhering to the key messages. The most frequently mentioned suggestion for helping community members eat according to the MyPyramid were to raise awareness (n = 93), provide information (n = 65), and improve the taste of or provide opportunity to taste (n = 49). Conclusions and Implications: This study captured participants' cultural perspectives of the MyPyramid key messages. Results indicate that both social marketing campaigns and intervention efforts focused on individual-level factors are needed to promote the MyPyramid in this disadvantaged Delta region. (Contains 4 tables.)

An understanding of the experience of food insecurity by children is essential for better measurement and assessment of its effect on children's nutritional, physical, and mental health. Our qualitative study explored children's perceptions of household food insecurity to identify these perceptions and to use them to establish components of children's food insecurity experience. Children (n - 32; 11-16 y old) from after school programs and a middle school in low-income areas participated in individual semistructured in-depth interviews. Children as young as 11 y could describe behaviors associated with food insecurity if they had experienced it directly or indirectly. Using the constant comparative method of qualitative data analysis, children's descriptions of behaviors associated with food insecurity were categorized into components of quantity of food, quality of food, psychological aspects, and social aspects described in the household food insecurity literature. Aspects of quantity included eating less than usual and eating more or eating fast when food was available. Aspects of quality included use of a few kinds of low-cost foods. Psychological aspects included worry/anxiety/sadness about the family food supply, feelings of having no choice in the foods eaten, shame/fear of being labeled as poor, and attempts to shield children. Social aspects of food insecurity centered on using social networks to acquire food or money and social exclusion. These results provide valuable information in understanding the effect of food insecurity on children's well-being especially relative to the social and emotional aspects of well-being. J. Nutr. 135: 1683-1690, 2005. KEY WORDS: * food security * hunger * children * qualitative research

Cognitive interviewing methods were used to adapt questions from the U.S. Food Security Survey Module for administration to children. Individual concurrent probing techniques using standardized probes were utilized to assess understanding of the items with 20 African American children (10 males, 10 females, aged 11-13 y). Item wording and response sets were revised, and small groups of boys (n = 5) and girls (n = 14) aged 12-15 y were asked to complete the 9-item survey. Retrospective probing techniques were then used to assess comprehension of items and response sets. Nine items were then piloted in a middle school using a self-administered format. Three hundred forty-five surveys were returned. The majority of the students were between 12 and 15 y (n = 215). Scaling analysis of the 345 completed surveys using statistical methods based on the Rasch measurement model indicated that the module measured a single underlying phenomenon (food insecurity) with sufficient reliability to be a useful tool. The measurable range of food insecurity was about 6 times the estimated measurement error, indicating that the scale could identify 3 categories of food security with reasonable reliability. A survey instrument that reliably measures food security status of individual children can provide researchers with an important tool to assess more accurately the individual-level effects of food security on nutritional status and mental and physical health among this population. J. Nutr. 134: 2566-2572, 2004. KEY WORDS: * food security * hunger * children * Rasch model * cognitive testing

Objective To collect and evaluate food intake data from a culturally diverse population and compare with national survey data. Design The Foods Of Our Delta Study was a baseline, cross-sectional survey that utilized random-digit dialing methodology to identify the sample. Food intake was obtained from a 24-hour dietary recall administered by computer-assisted telephone interview using the multiple-pass method Subjects/Setting One thousand seven hundred fifty-one adults and 485 children in the Lower Mississippi Delta (Delta) of Louisiana, Arkansas, and Mississippi. Statistical Analyses Performed Comparisons of subsets within the Delta were made using weighted t tests. Comparisons of the Delta with the overall US population from the US Department of Agriculture Continuing Survey of Food Intakes by Individuals and with the Dietary Reference Intakes were made using independent sample z tests of weighted estimates. Results Energy intake did not differ between the Delta and the US populations. Intakes of protein were lower, fat higher, and certain micronutrients lower in Delta adults than in US adults. Delta adults had a 20% lower intake of fruits and vegetables than the US adults and generally poorer adherence to recommendations of the Food Guide Pyramid. African American Delta adults generally consumed less-optimal diets than white Delta adults. Delta children had diets similar to children of the Continuing Survey of Food Intakes by Individuals sample population, but lower intakes were noted for vitamins A, C, riboflavin, and B-6, and for calcium and iron. Applications/Conclusions Data such as these will help drive intervention development in this rural region and perhaps set the stage for research in similarly impoverished areas. J Am Diet Assoc. 2004;104:199-207.

Abstract Background Walking for exercise remains the most frequently reported leisure-time activity, likely because it is simple, inexpensive, and easily incorporated into most people’s lifestyle. Pedometers are simple, convenient, and economical tools that can be used to quantify step-determined physical activity. Few studies have attempted to define the direct relationship between dynamic changes in pedometer-determined steps/day and changes in anthropometric and clinical outcomes. Hence, the objective of this secondary analysis was to evaluate the utility of several descriptive indicators of pedometer-determined steps/day for predicting changes in anthropometric and clinical outcomes using data from a community-based walking intervention, HUB City Steps, conducted in a southern, African American population. A secondary aim was to evaluate whether treating steps/day data for implausible values affected the ability of these data to predict intervention-induced changes in clinical and anthropometric outcomes. Methods The data used in this secondary analysis were collected in 2010 from 269 participants in a six-month walking intervention targeting a reduction in blood pressure. Throughout the intervention, participants submitted weekly steps/day diaries based on pedometer self-monitoring. Changes (six-month minus baseline) in anthropometric (body mass index, waist circumference, percent body fat [%BF], fat mass) and clinical (blood pressure, lipids, glucose) outcomes were evaluated. Associations between steps/day indicators and changes in anthropometric and clinical outcomes were assessed using bivariate tests and multivariable linear regression analysis which controlled for demographic and baseline covariates. Results Significant negative bivariate associations were observed between steps/day indicators and the majority of anthropometric and clinical outcome changes (r = -0.3 to -0.2: P < 0.05). After controlling for covariates in the regression analysis, only the relationships between steps/day indicators and changes in anthropometric (not clinical) outcomes remained significant. For example, a 1,000 steps/day increase in intervention mean steps/day resulted in a 0.1% decrease in %BF. Results for the three pedometer datasets (full, truncated, and excluded) were similar and yielded few meaningful differences in interpretation of the findings. Conclusions Several descriptive indicators of steps/day may be useful for predicting anthropometric outcome changes. Further, manipulating steps/day data to address implausible values has little overall effect on the ability to predict these anthropometric changes.

The health care industry has been slow to adopt the philosophy of focusing on patients as customers (1,2). However, competition for health care consumer dollars is forcing health care managers [...]

Background: Race/ethnic-specific physical activity patterns and biological responses to physical activity is one of the most understudied, yet critical aspects related to the development and adoption of physical activity recommendations. Methods: In this 6-month community walking intervention targeting African Americans, participants wore a pedometer and maintained a pedometer diary for the study duration. Outcome measures included height, weight, percent body fat, waist circumference, blood pressure, lipids and glucose. ANOVA, Pearson Correlations, and Kruskal-Wallis tests were used to examine changes in steps/day over each month nf the intervention and explore associations among pedometer-determined physical activity and anthropometric/ biological change scores from month 1 to 6. Results: The 83 participants were primarily African American (98%) women (94%). There was a significant increase in the average step/day beginning with 6665 (SD = 3,396) during month 1 and increasing to 9232 (SD = 3670) steps/day during month 6 (F = 4.5, P < .0001 ). Associations among step counts and anthropometric/biological change scores were not significant. Conclusions: While this intervention resulted in significant increases in steps/day; it exemplifies that physical activity standards may be unachievable for some vulnerable, minority communities. Methodological considerations for exploring associations between changes in pedometer-determined step counts and anthropometric/biological outcomes are emphasized through this study. [ABSTRACT FROM AUTHOR]

Background: Limited research has been done on the compliance and acceptability of maintaining pedometer diaries for an extensive time frame in community-based interventions targeting minority populations. Methods: Community "coaches" led participants in a 6-month community-based walking intervention that included wearing pedometers and maintaining pedometer diaries for the study duration. Descriptive statistics and ANOVA tests were used to evaluate compliance rates for maintaining diaries and daily step counts. After the intervention, focus groups were used to explore opinions regarding pedometers. Audiotapes were transcribed and evaluated using systematic content analysis. Results: The 8 coaches and 75 enrolled walking participants were primarily African American (98%) women (94%). Overall, the group (N = 83) submitted 85% of all possible pedometer diaries and recorded 73% of all possible daily step counts. Walkinggroup members were significantly (P < .01) more compliant if their coach was also compliant. Identified benefits of wearing pedometers and maintaining diaries outnumbered the barriers. Participants were enthusiastic about wearing the pedometers and indicated that the weekly diaries provided a source of motivation. Conclusions: This research suggests pedometer diaries are a viable intervention tool and research method for community-based physical activity interventions targeting Afri- can Americans and highlights the need for social support to promote pedometer diary compliance. [ABSTRACT FROM AUTHOR]

The purpose of this study was to better understand the barriers to health promotion among African American older men living in the rural Mississippi Delta. A qualitative, intrinsic case study approach was used to explore the phenomenon of health and the barriers to promoting men’s health within the unique context of the Delta. Data included one key informant interview and two focus group interviews with 14 men, with the majority between the ages of 41 and 55 years. Focus group participants were lay community members as well as members of a volunteer community health advisors men’s group. Findings underscore the extensiveness of the term “health” and the importance of attending to structural barriers in addressing men’s health. Three overarching themes emerged: “men don’t talk about health,” “health care is not just the issue, everything is,” and “we need a strong male to lead.” Implications for future research and health promotion efforts are provided. [ABSTRACT FROM AUTHOR]

Cognitive interviewing methods were used to adapt questions from the U.S. Food Security Survey Module for administration to children. Individual concurrent probing techniques using standardized probes were utilized to assess understanding of the items with 20 African American children (10 males, 10 females, aged 11–13 y). Item wording and response sets were revised, and small groups of boys (n = 5) and girls (n = 14) aged 12–15 y were asked to complete the 9-item survey. Retrospective probing techniques were then used to assess comprehension of items and response sets. Nine items were then piloted in a middle school using a self-administered format. Three hundred forty-five surveys were returned. The majority of the students were between 12 and 15 y (n = 215). Scaling analysis of the 345 completed surveys using statistical methods based on the Rasch measurement model indicated that the module measured a single underlying phenomenon (food insecurity) with sufficient reliability to be a useful tool. The measurable range of food insecurity was about 6 times the estimated measurement error, indicating that the scale could identify 3 categories of food security with reasonable reliability. A survey instrument that reliably measures food security status of individual children can provide researchers with an important tool to assess more accurately the individual-level effects of food security on nutritional status and mental and physical health among this population. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]