RESUMEN
OBJECTIVES: Massachusetts (MA) public schools conduct mandated body-mass index (BMI) screening and until recently, communicated results in a letter to parents/caregivers, to encourage primary care visits and provide aggregate data to the state Department of Public Health. This study assessed the letter's readability and qualitatively explored parents' responses to it. METHODS: Readability of the BMI letter was calculated. Audio-taped 1-h focus groups were conducted with parents/caregivers of 8- to 14-year-old obese (≥95th BMI-for-age percentile) children. A semi-structured interview guide was used to elicit responses. Qualitative content analysis was conducted on transcripts to identify emergent themes. RESULTS: Readability analysis showed higher grade levels than recommended. Eight focus groups consisting of two to six parents each were conducted (n=29); 83% were female, mean age 41±9years, and 65% self-identified as Hispanic/Latino. Key themes identified included usefulness of the BMI letter, concerns about utility of BMI for screening, concerns about impacting self-esteem, and failure to understand the letter. CONCLUSIONS: The MA BMI letter may not have been achieving its desired goal with some parents. PRACTICE IMPLICATIONS: Emergent themes from this study could be used to test effectiveness of similar BMI letters nationwide and develop strategies to improve communication to parents.
Asunto(s)
Índice de Masa Corporal , Comprensión , Obesidad/prevención & control , Padres , Lectura , Adolescente , Adulto , Anciano , Niño , Femenino , Grupos Focales , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Investigación Cualitativa , Grabación en Cinta , Adulto JovenRESUMEN
This article examined the views of college mentors who administered Challenge!-a home- and community-based health promotion/overweight prevention intervention that effectively reduced the progression to overweight among African American adolescents. In-depth qualitative interviews among 17 mentors (81%) conducted 1 year following the intervention yielded four primary findings: (a) the importance of a strong mentor-mentee relationship often extending beyond the issues of diet and physical activity, (b) concern at the adversities the adolescents faced (e.g., poverty and household instability); (c) the personal impact of the mentoring process on the mentors' own dietary and physical activity behavior and career choices; and (d) recommendations regarding subsequent mentoring programs. In summary, college students are a valuable resource as mentors for low-income, African American adolescents and provide insights into the success of health promotion/overweight prevention interventions.
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Negro o Afroamericano/estadística & datos numéricos , Conductas Relacionadas con la Salud/etnología , Promoción de la Salud/métodos , Mentores/estadística & datos numéricos , Obesidad/prevención & control , Pobreza/estadística & datos numéricos , Adolescente , Adulto , Índice de Masa Corporal , Femenino , Humanos , Relaciones Interpersonales , Masculino , Obesidad/etnología , Encuestas y Cuestionarios , Estados Unidos , Universidades , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Low-income, urban African-American youth are at higher risk for obesity and less likely to meet dietary recommendations than white, higher-income youth. Patterns of food purchasing among youth likely contribute to these disparities, but little published information is available. PURPOSE: To investigate food purchasing behaviors of low-income, urban African-American youth. METHODS: A total of 242 African-American youth, aged 10-14 years, were recruited from 14 recreation centers in low-income, predominantly African-American neighborhoods in Baltimore MD. Youth reported the amount of money typically spent on food, the source of this money, the place of purchase, and frequency of purchase for 29 foods and beverages. Data were collected in 2008-2009 and analyzed in 2009-2010. RESULTS: Youth reported spending an average of $3.96 on foods and beverages in a typical day. Corner stores were the most frequently visited food source (youth made purchases at these stores an average of 2.0 times per week). Chips, candy, and soda were the most commonly purchased items, with youth purchasing these an average of 2.5, 1.8, and 1.4 times per week, respectively. Older age was associated with more money spent on food in a typical day (p<0.01). CONCLUSIONS: Food purchasing among low-income, urban African-American youth is frequent and substantial. Interventions aimed at preventing and treating obesity in this population should focus on increasing access to healthy foods in their neighborhoods, especially in corner stores.
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Negro o Afroamericano/estadística & datos numéricos , Conducta Alimentaria , Alimentos/economía , Disparidades en el Estado de Salud , Adolescente , Baltimore , Niño , Humanos , Masculino , Política Nutricional , Obesidad/epidemiología , Obesidad/etiología , Pobreza , Población UrbanaRESUMEN
Based on substantial formative research, the authors developed and implemented a year-long corner store-based program in East Baltimore focusing on Korean American (KA) stores. To understand acceptability of the intervention by storeowners, the authors examined the motivating factors for program participation, barriers to program implementation, perceived effectiveness of intervention materials, and perceptions about the program. Data collection methods included in-depth interviews with seven corner store owners, field notes by interventionists, and a follow-up survey. Stores varied considerably in terms of owners' perceptions about the program, supportive atmosphere, and acceptability of intervention strategies. The storeowners who showed strong or moderate support for the program were more likely to sustain the stocking of promoted foods such as cooking spray and baked or low-fat chips after the program was completed as compared to less supportive stores. The level of support and active participation of storeowners can greatly influence the success of corner store-based nutrition interventions.
Asunto(s)
Asiático/psicología , Negro o Afroamericano , Promoción de la Salud/métodos , Ciencias de la Nutrición/educación , Baltimore/epidemiología , Competencia Cultural , Conducta Alimentaria/etnología , Industria de Alimentos/economía , Industria de Alimentos/normas , Humanos , Entrevistas como Asunto , Mercadotecnía/economía , Mercadotecnía/normas , Percepción , Evaluación de Programas y Proyectos de Salud/métodos , Pequeña Empresa/economía , Pequeña Empresa/normasRESUMEN
OBJECTIVES: The objective of this study was to evaluate a 12-session home/community-based health promotion/obesity prevention program (Challenge!) on changes in BMI status, body composition, physical activity, and diet. METHODS: A total of 235 black adolescents (aged 11-16 years; 38% overweight/obese) were recruited from low-income urban communities. Baseline measures included weight, height, body composition, physical activity (PA), and diet. PA was measured by 7-day play-equivalent physical activity (> or =1800 activity counts per minute). Participants were randomly assigned to health promotion/obesity prevention that is anchored in social cognitive theory and motivational interviewing and was delivered by college-aged black mentors or to control. Postintervention (11 months) and delayed follow-up (24 months) evaluations were conducted. Longitudinal analyses used multilevel models with random intercepts and generalized estimating equations, controlling for baseline age/gender. Stratified analyses examined baseline BMI category. RESULTS: Retention was 76% over 2 years; overweight/obese status declined 5% among intervention adolescents and increased 11% among control adolescents. Among overweight/obese youth, the intervention reduced total percentage of body fat and fat mass and increased fat-free mass at delayed follow-up and increased play-equivalent physical activity at postintervention but not at delayed follow-up. Intervention adolescents declined significantly more in snack/dessert consumption than control adolescents at both follow-up evaluations. CONCLUSIONS: At postintervention, there were intervention effects on diet and PA but not BMI category or body composition. At delayed follow-up, dietary changes were sustained and the intervention prevented an increase in BMI category. Body composition was improved for overweight/obese youth. Changes in body composition follow changes in diet and PA and may not be detected immediately after intervention.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Promoción de la Salud , Mentores , Obesidad/etnología , Obesidad/prevención & control , Población Urbana/estadística & datos numéricos , Adolescente , Índice de Masa Corporal , Áreas de Influencia de Salud , Niño , Femenino , Humanos , Masculino , Motivación , Actividad Motora , Prevalencia , Retención en Psicología , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.
Asunto(s)
Negro o Afroamericano/psicología , Manipulación de Alimentos , Preferencias Alimentarias/etnología , Preferencias Alimentarias/psicología , Educación en Salud , Obesidad/prevención & control , Áreas de Pobreza , Población Urbana , Adulto , Baltimore , Conducta de Elección , Culinaria , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Intención , Estilo de Vida , Masculino , Persona de Mediana Edad , Valor Nutritivo , AutoeficaciaRESUMEN
Reduced access to affordable healthy foods is linked to higher rates of chronic diseases in low-income urban settings. The authors conduct a feasibility study of an environmental intervention (Baltimore Healthy Stores) in seven corner stores owned by Korean Americans and two supermarkets in low-income East Baltimore. The goal is to increase the availability of healthy food options and to promote them at the point of purchase. The process evaluation is conducted largely by external evaluators. Participating stores stock promoted foods, and print materials are displayed with moderate to high fidelity. Interactive consumer taste tests are implemented with high reach and dose. Materials developed specifically for Korean American corner store owners are implemented with moderate to high fidelity and dose. Results indicate that small food store-based intervention programs are feasible to implement and are a viable means of increasing healthy food availability and a good location for point-of-purchase promotions in low-income urban settings.
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Abastecimiento de Alimentos , Promoción de la Salud/organización & administración , Pobreza , Pequeña Empresa/organización & administración , Asiático , Baltimore , Humanos , Proyectos Piloto , República de Corea/etnologíaRESUMEN
OBJECTIVE: While corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores. DESIGN: Quasi-experimental study. SETTING: Corner stores owned by Korean-Americans and supermarkets located in East and West Baltimore. SUBJECTS: Seven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison. RESULTS: During and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners. CONCLUSIONS: Findings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.
Asunto(s)
Comercio/normas , Dieta/normas , Abastecimiento de Alimentos/normas , Promoción de la Salud/métodos , Baltimore , Comercio/economía , Dieta/economía , Abastecimiento de Alimentos/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Pobreza , Población UrbanaRESUMEN
PRIMARY OBJECTIVE: To provide nutritional composition data for commonly consumed traditional Apache foods to enable an assessment of dietary intake and to evaluate a food-store based intervention aimed at reducing risk of chronic disease. METHODS AND PROCEDURES: Weighed recipes were collected in Apache households on the White Mountain Apache reservation in Arizona. The nutritional composition was calculated using the U.S. Department of Agriculture National Nutrient Database. MAIN OUTCOMES AND RESULTS: A total of 47 weighed recipes were collected for 13 traditional Apache dishes; five were breads, five were chicken or meat-based stews, two were tortilla-based dishes and the remaining one was a traditional Indian dumpling. The calculated energy, macronutrient content and micronutrient content of these traditional foods are provided. CONCLUSIONS: We have provided for the first time the nutritional composition per 100 g for 13 traditional Apache foods. These data are essential for determining dietary intake and diet-disease associations and for developing and evaluating the effectiveness of a food-store-based intervention in this population.
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Dieta , Alimentos , Indígenas Norteamericanos , Encuestas Nutricionales , Arizona , Grano Comestible , Ingestión de Energía , Frutas , Humanos , Carne , Valor Nutritivo , VerdurasRESUMEN
OBJECTIVE: To demonstrate how dietary data collected from 24-hour dietary recalls were incorporated into the development of a quantitative food-frequency questionnaire (QFFQ) for the Apache in Arizona. DESIGN: A cross-sectional study was first conducted using 24-hour dietary recalls to identify foods for inclusion on a QFFQ that would be used to evaluate a nutrition intervention. SETTING: The White Mountain and San Carlos Apache reservations in East-central Arizona. SUBJECTS: The 24-hour dietary recalls were collected from a random sample of 53 adults (34 women and 19 men). RESULTS: A QFFQ was developed that included all foods reported by two or more respondents, plus traditional and seasonal foods. Portion size was assessed using familiar household units and culturally appropriate food models. The final instrument contains 155 foods. Frequency of consumption is assessed using eight categories ranking from 'never or less than once a month' to '2 or more times a day'. Nutrient intakes and the five major food sources of energy, fat and sugar are presented. CONCLUSION: The QFFQ developed is complete and up-to-date for assessing usual food and nutrient intake for the Apache in Arizona. The instrument will be used to evaluate a food store-based nutrition intervention to reduce risk of chronic diseases.
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Encuestas sobre Dietas , Dieta/normas , Conducta Alimentaria , Encuestas y Cuestionarios/normas , Adulto , Arizona , Estudios Transversales , Carbohidratos de la Dieta/administración & dosificación , Grasas de la Dieta/administración & dosificación , Ingestión de Energía , Femenino , Humanos , Masculino , Recuerdo Mental , Fenómenos Fisiológicos de la Nutrición , Reproducibilidad de los Resultados , Estaciones del AñoRESUMEN
Pregnant adolescents are at particular risk for both inadequate and excessive gestational weight gain and for inadequate intake of micronutrients that support healthy fetal development. This article reviews the available literature on prenatal nutrition interventions intended to address such risks to identify effective strategies and needs for further research. A medical model providing enhanced prenatal care aimed at improved birth weight predominated. No studies rigorously evaluated the independent influence of nutrition education on prenatal dietary behaviors or outcomes; few applied a conceptual framework or targeted dietary attitudes, behaviors, skills, or self-efficacy. Positive effect on birth outcomes was evident, likely due to multidisciplinary teams supporting the special psychosocial needs of pregnant adolescents; individualized education and counseling encouraging optimal dietary choice and appropriate gestational weight gain; home visits providing prenatal education, support, and outreach to highest-risk teens; visual presentation and tracking of gestational weight gain; and support/discussion groups. Nevertheless, greater effects could likely be achieved by applying behavior-change strategies that have been implemented effectively with other, similar populations. Further research is needed to test such approaches with pregnant, high-risk teens.
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Fenómenos Fisiológicos Nutricionales de los Adolescentes/fisiología , Dieta/normas , Conocimientos, Actitudes y Práctica en Salud , Política Nutricional , Fenómenos Fisiologicos de la Nutrición Prenatal/fisiología , Aumento de Peso/fisiología , Adolescente , Conducta del Adolescente , Peso al Nacer , Femenino , Educación en Salud , Humanos , Necesidades Nutricionales , Embarazo , Factores de Riesgo , AutoeficaciaRESUMEN
OBJECTIVE: Obesity and other diet-related chronic diseases affect American Indians at high rates, yet little is known about food use behaviors in this population, or of psychosocial factors that influence these behaviors. The study objective was to address this gap. DESIGN: Cross-sectional; part of baseline collection for an intervention trial. SETTING: White Mountain and San Carlos Apache reservations, Arizona. PARTICIPANTS: Main household food shoppers and preparers of 270 randomly selected households on two American Indian reservations. ANALYSIS: Multivariate linear regression. VARIABLES MEASURED: Primary independent variables were healthy food knowledge, self-efficacy and intentions, assessed using multi-question scales. Dependent variables were frequency of purchasing healthy foods and a healthiness of cooking methods score. RESULTS: Higher-fat and/or higher-sugar items were commonly purchased, with limited purchasing of healthier alternatives. Pre-prepared foods are a substantial component of the diet. Cooking methods which add or have little impact on the fat content of foods were more commonly employed than methods which reduce fat. Food acquisition and use behaviors were predicted by food use intentions. Food intention scores were predicted by food self-efficacy; food self-efficacy by food knowledge. CONCLUSIONS AND IMPLICATIONS: These findings support the use of food knowledge, self-efficacy, and intentions in understanding food-related behavior in this setting.
Asunto(s)
Conducta Alimentaria , Manipulación de Alimentos/métodos , Preferencias Alimentarias/psicología , Conocimientos, Actitudes y Práctica en Salud , Indígenas Norteamericanos/psicología , Autoeficacia , Adulto , Femenino , Abastecimiento de Alimentos , Humanos , Renta , Indígenas Norteamericanos/estadística & datos numéricos , Masculino , Análisis Multivariante , Asistencia PúblicaRESUMEN
OBJECTIVE: This study sought to determine how dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were associated with body size among adolescent African-American mothers 1 year after delivery and with changes in body size over the next year. DESIGN: Cross-sectional and longitudinal self-reported measures were collected 1 year after delivery. Weight and height were collected 1 and 2 years after delivery. SUBJECTS: The subjects were 118 low-income, African-American adolescent mothers recruited after the birth of their first child. STATISTICAL ANALYSES: Multivariate analysis of covariance and multivariate regression analysis were conducted to examine predictors of body size 1 year after delivery and changes in body size over the next year. Analyses were adjusted for maternal age, education, breastfeeding history, and intervention. RESULTS: One year after delivery, 33.0% of mothers were overweight (body mass index [BMI] > or =95th percentile) and 23.7% were at risk for overweight (BMI > or =85th and <95th percentile). Mothers consumed a daily average of 2,527 kcal and 4.1 high-fat snacks. A total of 11% of normal-weight mothers, 22% of mothers at risk for overweight, and 44% of overweight mothers reported intention to lose weight, chi(2)=10.8, P<.01. Average maternal BMI z score increased 0.13 (3.9 kg) between 1 and 2 years after delivery, P<.01. Dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were not related to body size or increase in body size. CONCLUSIONS: One year after delivery, overweight among adolescent mothers was common and increased over time. Although nearly half of overweight mothers reported an intention to lose weight, their weight gain did not differ from that of other mothers, suggesting that they lack effective weight-loss behaviors, and may be good candidates for intervention. African-American adolescent mothers have high rates of overweight and snack consumption and may benefit from strategies to identify nutritious, palatable, affordable, and accessible alternatives to high-fat snack food.
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Negro o Afroamericano , Ciencias de la Nutrición del Niño/educación , Conducta Alimentaria/psicología , Madres/psicología , Obesidad/psicología , Aumento de Peso , Adolescente , Análisis de Varianza , Estudios Transversales , Depresión/complicaciones , Conducta Alimentaria/fisiología , Femenino , Servicios de Alimentación , Promoción de la Salud , Humanos , Estudios Longitudinales , Obesidad/terapia , Periodo Posparto , Pobreza , Análisis de Regresión , AutoimagenRESUMEN
Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.
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Comercio , Promoción de la Salud/métodos , Indígenas Norteamericanos , Obesidad/prevención & control , Arizona , Conducta Alimentaria , Humanos , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
OBJECTIVE: To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention targeting American Indians. METHODS: Formative research included interviews, assessment of food- purchasing frequency and preparation methods, and dietary recalls. Stakeholders contributed to intervention development through formative research, a program planning workshop, group feedback, and implementation training. RESULTS: Foods high in fat and sugar are commonly consumed. Barriers to healthy eating include low availability, perceived high cost, and poor flavor. Stakeholder participation contributed to the development of a culturally appropriate intervention. CONCLUSIONS: This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program.
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Promoción de la Salud , Obesidad/terapia , Proyectos de Investigación , Actitud Frente a la Salud , Comercio , Modas Dietéticas , Retroalimentación , Preferencias Alimentarias , Alimentos Orgánicos , Humanos , Obesidad/prevención & control , Desarrollo de Programa , Enseñanza/métodosRESUMEN
Data collected as part of Pathways, a school-based trial for the primary prevention of obesity in American Indian children conducted between 1997 and 2000, were analyzed to examine possible intervention-related bias in food reporting. The authors hypothesized that children in the intervention schools may have systematically underreported their dietary intake relative to children in the control schools. Nutrient intake estimates for lunch derived from record-assisted 24-hour dietary recalls were compared with intake estimates from observed lunch intakes. Reported nutrient intakes were included in regression analyses as the dependent variables; observed intake, intervention condition, and age were included as independent variables. Results indicated that, among females, intervention condition was a significant predictor of reported energy, fat, and saturated fatty acid intakes. Independently of observed intake, reported lunch energy intake among females in the intervention schools was 66.8 calories lower than reported intake among females in the control schools (p = 0.03). These findings suggest that investigators should consider bias in reporting of dietary intake by intervention condition when conducting diet-focused intervention studies. Specifically, enhancing measures that rely on self-reports with objective measures of dietary intake would help investigators to evaluate whether differential reporting by treatment group has occurred.
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Sesgo , Dieta , Indígenas Norteamericanos , Obesidad/prevención & control , Niño , Encuestas sobre Dietas , Femenino , Humanos , Masculino , Evaluación Nutricional , Estados UnidosRESUMEN
OBJECTIVE: To examine the validity of a modified diet record-assisted 24-hour recall in third-grade (8 to 10 years old) American Indian children. DESIGN: The children were trained to record their food intake using diet records, and then they recalled their 24-hour food intakes, using the diet records as memory prompts, during interviews by trained staff using the Minnesota Nutrition Data System (NDS; version 2.6, 1993, Food database version 8A, Nutrient database version 23; Nutrition Coordinating Center, University of Minnesota, Minneapolis). The modified method added training in portion size estimation. Direct observation of the children's intakes during school meals was used to validate the accuracy of their self-reported recalls. SUBJECTS: Eighty third-grade children recruited from schools from four of the American Indian Nations participating in the Pathways Study. Statistical analyses performed Pearson correlations were used for nutrient level data. A mixed regression model (PROC MIXED), with no other fixed effects and site as a random effect, was used to test the null hypothesis that the difference between recalled and observed intakes was zero (H(o): beta(o)=0). Food intake data were obtained from the Nutrition Data System Record Reports. RESULTS: There were no significant differences between recalled and observed energy intakes for the school meals combined or for either meal individually. Percentages of energy intake from fat, protein, and carbohydrate from recalls were not significantly different from those observed for the combined school meals. Pearson correlations for energy and energy-providing nutrients ranged from 0.52 to 0.86 for both meals, from 0.55 to 0.86 for school lunch, and from 0.61 to 0.86 for school breakfast. Agreement between recalled and observed food items was 75%. Children recalled 57% of food quantities within +/-10% of observed quantities. CONCLUSIONS: At the group level, American Indian children were able to accurately report the macronutrient proportions of their total energy intake, and their reporting of total energy intake (+13% of criterion) compares favorably with that of other ethnic groups of children of similar age. They were able to accurately recall the majority of foods that they were independently observed consuming during school meals.
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Registros de Dieta , Ingestión de Alimentos/psicología , Servicios de Alimentación , Indígenas Norteamericanos , Autorrevelación , Niño , Ingestión de Energía , Femenino , Humanos , Masculino , Recuerdo Mental , Análisis de Regresión , Reproducibilidad de los Resultados , Instituciones Académicas , Sensibilidad y Especificidad , Estados UnidosRESUMEN
BACKGROUND: Pathways, a randomized trial, evaluated the effectiveness of a school-based multicomponent intervention to reduce fatness in American-Indian schoolchildren. The goal of the Pathways food service intervention component was to reduce the fat in school lunches to no more than 30% of energy from fat while maintaining recommended levels of calories and key nutrients. METHODS: The intervention was implemented by school food service staff in intervention schools over a 3-year period. Five consecutive days of school lunch menu items were collected from 20 control and 21 intervention schools at four time periods, and nutrient content was analyzed. RESULTS: There was a significantly greater mean reduction in percent energy from fat and saturated fat in the intervention schools compared to the control schools. Mean percentages of energy from fat decreased from 33.1% at baseline to 28.3% at the end of the study in intervention schools compared to 33.2% at baseline and 32.2% at follow-up in the control schools (P<0.003). There were no statistically significant differences for calories or nutrients between intervention and control schools. CONCLUSIONS: The Pathways school food lunch intervention documented the feasibility of successfully lowering the percent of energy from fat, as part of a coordinated obesity prevention program for American-Indian children.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles , Servicios de Alimentación/normas , Indígenas Norteamericanos/estadística & datos numéricos , Obesidad/etnología , Obesidad/prevención & control , Prevención Primaria , Instituciones Académicas , Niño , Grasas de la Dieta/administración & dosificación , Femenino , Humanos , Masculino , Valor Nutritivo , Estados UnidosRESUMEN
BACKGROUND: Pathways was a multisite, multicomponent obesity prevention intervention for American-Indian schoolchildren. The goal of the school breakfast and lunch component was to reduce fat content of school meals to 30% or fewer calories from fat without compromising dietary quality. METHODS: An intensive 3-year intervention was implemented with school food service staff. Five consecutive days of school breakfast menu and recipe information was collected at 20 control and 19 intervention schools at four time intervals. Data were analyzed at nutrient and (in final year) food levels. RESULTS: Average total fat decreased in intervention schools from 16.0 grams at baseline to 13.6 grams by end of study, compared with 16.6 and 16.7 grams at baseline and final measurement in control schools (P<0.030). Percentage of calories from saturated fat were also significantly reduced from 12.0 to 8.9%, compared with 12.1 to 10.6% in control schools (P<0.014). There were no significant differences in total energy or other nutrients by treatment condition across four time points. Food-level data revealed a consistent pattern of more lower-fat items served in intervention schools compared to control schools. CONCLUSIONS: Pathways was successful in achieving its overall goal of reducing dietary fat in meals served for school breakfasts.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles , Servicios de Alimentación/normas , Indígenas Norteamericanos/estadística & datos numéricos , Obesidad/etnología , Obesidad/prevención & control , Prevención Primaria , Instituciones Académicas , Niño , Femenino , Humanos , Masculino , Valor Nutritivo , Evaluación de Programas y Proyectos de Salud , Estados UnidosRESUMEN
BACKGROUND: The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. METHODS: We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. RESULTS: Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. CONCLUSIONS: Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.