510 results on '"Frongillo EA"'
Search Results
402. Discussion: Targeting is making trade-offs.
- Author
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Habicht JP and Frongillo EA
- Subjects
- Humans, United States, Delivery of Health Care, Health Policy, Nutritional Physiological Phenomena
- Abstract
The previous articles presented different aspects of targeting: the implicit political implications, the trade-offs in giving power to different stakeholders to decide and to implement targeting, perceptions of frontline workers in implementing a program, and a technical article about selecting a scale for targeting, which we review in greater detail. It is well recognized that targeting results in a trade-off between not serving those who should be served and including those who should not be served. Less well recognized are the trade-offs that are the consequences of deciding between using indicators of risk vs. using indicators that predict benefit.
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- 2005
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403. Meanings of targeting from program workers.
- Author
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Lee JS, Frongillo EA, and Olson CM
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- Aged, Humans, Middle Aged, Nutrition Surveys, Public Assistance, United States, Food Services, Health Education, Health Services for the Aged organization & administration, Nutritional Sciences education
- Abstract
Program workers have a critical role in targeting in nutrition programs, but little has been studied about the concept and the operation of targeting from their perspectives. This paper introduces and compares meanings of targeting from the perspectives of program workers in food assistance programs in the United States. There exist some variations in perceptions of targeting and actual operational procedures adopted by program workers at the local and federal levels. Regardless, program workers' perspectives on targeting suggest a new framework of targeting, which consists of key components (program access, service, and evaluation) and issues in need of careful attention in targeting nutrition programs. The success of targeting depends on how well these components and related issues can be translated into targeting policy, rules, and procedures. With increased devolution to the state and local levels in the United States, it is even more critical for federal policy makers and administrators to understand how frontline program workers perceive and implement targeting. The new framework based on the perspectives of program workers may contribute to developing a conceptual definition as well as practical guidance for targeting that can be used to formulate better ways of targeting in nutrition programs.
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- 2005
- Full Text
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404. Understanding targeting from the perspective of program providers in the elderly nutrition program.
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Lee JS, Frongillo EA, and Olson CM
- Subjects
- Adult, Aged, Female, Food Services economics, Humans, Interviews as Topic, Male, Middle Aged, Needs Assessment, Reproducibility of Results, Food Services organization & administration, Program Evaluation
- Abstract
Providers' perspectives on need, strategies, and challenges are critical in targeting of programs. This study was undertaken to understand the meanings and challenges of targeting from the perspectives of program providers in the Elderly Nutrition Program (ENP). Qualitative in-depth interviews were done with a sample of 36 local ENP providers from six counties in upstate New York. Each interview was tape-recorded, transcribed, and analyzed. Qualitative analysis revealed four distinct meanings of targeting including maximum outreach, reaching out to the most needy, serving only the most needy, and evaluating coverage. Regardless of the meaning or type of targeting, local providers reported universal challenges for outreach, need assessment, and resources in implementing targeting. Understanding these different meanings about targeting could contribute to crafting better targeting policies and program procedures to deliver adequate nutrition service to elders in need in the community.
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- 2005
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405. Conceptualizing and assessing nutrition needs: perspectives of local program providers.
- Author
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Lee JS, Frongillo EA Jr, and Olson CM
- Subjects
- Adult, Aged, Aging physiology, Female, Health Promotion methods, Humans, Interviews as Topic, Male, Middle Aged, New York, Nutrition Disorders prevention & control, Nutritional Sciences education, Community Health Services methods, Food Services, Needs Assessment, Nutrition Assessment
- Abstract
This study aimed to understand how local Older American Acts Nutrition Program (OAANP) providers perceive and assess client need for the OAANP. Qualitative in-depth interviews were done with a sample of 36 local OAANP providers in upstate New York. Providers' perceptions of needs for the OAANP were determined by comprehensive understanding of the extent to which an elderly person has problems eating properly to maintain good nutritional and health status. Need was determined by various aging and environmental factors including food insecurity of the elderly, rather than by a single characteristic of problems of elders. Efforts to better understand and meet the needs of elders will enable nutrition programs to respond to heterogeneous needs in ever increasing older population.
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- 2005
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406. Methodology for estimating regional and global trends of child malnutrition.
- Author
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de Onis M, Blössner M, Borghi E, Morris R, and Frongillo EA
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- Child, Growth Disorders epidemiology, Humans, Linear Models, Prevalence, Child Nutrition Disorders epidemiology, Child Nutritional Physiological Phenomena, Developing Countries, Global Health
- Abstract
Background: Child malnutrition is an important indicator for monitoring progress towards the Millennium Development Goals (MDG). This paper describes the methodology developed by the World Health Organization (WHO) to derive global and regional trends of child stunting and underweight, and reports trends in prevalence and numbers affected for 1990-2005., Methods: National prevalence data from 139 countries were extracted from the WHO Global Database on Child Growth and Malnutrition. A total of 419 and 388 survey data points were available for underweight and stunting, respectively. To estimate trends we used linear mixed-effect models allowing for random effects at country level and for heterogeneous covariance structures. One model was fitted for each United Nation's region using the logit transform of the prevalence and results back-transformed to the original scale. Best models were selected based on explicit statistical and graphical criteria., Results: During 1990-2000 global stunting and underweight prevalences declined from 34% to 27% and 27% to 22%, respectively. Large declines were achieved in Eastern and South-eastern Asia, while South-central Asia continued to suffer very high levels of malnutrition. Substantial improvements were also made in Latin America and the Caribbean, whereas in Africa numbers of stunted and underweight children increased from 40 to 45, and 25 to 31 million, respectively., Conclusion: Linear mixed-effect models made best use of all available information. Trends are uneven across regions, with some showing a need for more concerted and efficient interventions to meet the MDG of reducing levels of child malnutrition by half between 1990 and 2015.
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- 2004
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407. Factors associated with unconstrained growth among affluent Ghanaian children.
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Owusu WB, Lartey A, de Onis M, Onyango AW, and Frongillo EA
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- Analysis of Variance, Cross-Sectional Studies, Female, Ghana epidemiology, Humans, Infant, Infant Nutrition Disorders epidemiology, Infant Nutrition Disorders prevention & control, Male, Mass Screening, Reference Values, Regression Analysis, Anthropometry, Growth physiology, Social Class
- Abstract
Aim: To identify socio-economic factors associated with unconstrained growth among children living in well-off neighbourhoods of Accra, Ghana., Methods: A cross-sectional study involving the assessment of the anthropometric status of preschool children. Children (n = 309) between the ages of 12 and 23 mo who live in affluent communities in Accra, Ghana were recruited for the study. Weight, length and mid-upper arm circumference were taken. Information was collected on household demographics and socio-economic status, including parental education and household income. Associations between these variables and attained growth were analysed to establish cut-offs for screening children with unconstrained growth., Results: The mean weight-for-age (WA), length-for-age (LA) and weight-for-length (WL) Z-scores of the sub-sample selected on the basis of high socio-economic criteria were -0.18, -0.40 and 0.16, respectively. Among these well-off children, 0% were underweight, 3.0% were stunted and 0% were wasted (Z-scores <-2). Factors associated with better anthropometric status were paternal education and household income. Two screening criteria combining the two variables were selected: polytechnic education and income > 1,000,000 cedis (435 US dollars) or university education and income > 200,000 cedis., Conclusions: The children experiencing unconstrained growth belonged to a sub-population of affluent households characterized by high paternal education and household income. This subpopulation was targeted for screening for the WHO Multicentre Growth Reference Study in Ghana.
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- 2004
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408. Maternal obesity is negatively associated with breastfeeding success among Hispanic but not Black women.
- Author
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Kugyelka JG, Rasmussen KM, and Frongillo EA
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- Adult, Analysis of Variance, Body Mass Index, Female, Humans, Medical Records, New York, Black or African American, Black People, Breast Feeding ethnology, Hispanic or Latino, Lactation metabolism, Obesity metabolism
- Abstract
Prepregnant overweight and obesity have been associated with failure to initiate and to sustain breastfeeding (BF) among Caucasian women; however, this relationship has not been studied among either Black or Hispanic women. Information extracted from medical records was used to examine the relationship between prepregnant overweight (BMI = 26.1-29.0 kg/m(2)) and obesity (BMI > 29.0 kg/m(2)) and the initiation and duration of BF among Black and Hispanic women living in an urban area. Among 587 Hispanic women, those who were obese were more likely than normal-weight women to feed formula and breast milk rather than to feed breast milk alone before discharge [odds ratio (OR): 1.9; 95% CI: 1.2-3.1]. Obese Hispanic women also had higher rates of discontinuation of exclusive BF [relative risk (RR): 1.5; 95% CI: 1.1-2.0]) and higher rates of discontinuation of BF to any extent (RR: 1.5; 95% CI: 1.1-2.1) during the first 6 mo postpartum. Among 640 Black women, prepregnant BMI was neither associated with differences in feeding pattern before discharge nor with differences in rates of discontinuation of exclusive or any BF. We concluded that among healthy women who attempt to breastfeed in the hospital, maternal prepregnant obesity was negatively associated with initiation and duration of BF in Hispanic women. In contrast, prepregnant BMI did not have the same association among Black women who attempted to breastfeed. We speculate that obesity may have a different biological meaning for BF success in Black women than it does in those who are Caucasian or Hispanic.
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- 2004
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409. Estimates of global prevalence of childhood underweight in 1990 and 2015.
- Author
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de Onis M, Blössner M, Borghi E, Frongillo EA, and Morris R
- Subjects
- Child, Preschool, Humans, Infant, Nutrition Surveys, Prevalence, Body Weight, Child Nutrition Disorders epidemiology, Global Health, Infant Nutrition Disorders epidemiology
- Abstract
Context: One key target of the United Nations Millennium Development goals is to reduce the prevalence of underweight among children younger than 5 years by half between 1990 and 2015., Objective: To estimate trends in childhood underweight by geographic regions of the world., Design, Setting, and Participants: Time series study of prevalence of underweight, defined as weight 2 SDs below the mean weight for age of the National Center for Health Statistics and World Health Organization (WHO) reference population. National prevalence rates derived from the WHO Global Database on Child Growth and Malnutrition, which includes data on approximately 31 million children younger than 5 years who participated in 419 national nutritional surveys in 139 countries from 1965 through 2002., Main Outcome Measures: Linear mixed-effects modeling was used to estimate prevalence rates and numbers of underweight children by region in 1990 and 2015 and to calculate the changes (ie, increase or decrease) to these values between 1990 and 2015., Results: Worldwide, underweight prevalence was projected to decline from 26.5% in 1990 to 17.6% in 2015, a change of -34% (95% confidence interval [CI], -43% to -23%). In developed countries, the prevalence was estimated to decrease from 1.6% to 0.9%, a change of -41% (95% CI, -92% to 343%). In developing regions, the prevalence was forecasted to decline from 30.2% to 19.3%, a change of -36% (95% CI, -45% to -26%). In Africa, the prevalence of underweight was forecasted to increase from 24.0% to 26.8%, a change of 12% (95% CI, 8%-16%). In Asia, the prevalence was estimated to decrease from 35.1% to 18.5%, a change of -47% (95% CI, -58% to -34%). Worldwide, the number of underweight children was projected to decline from 163.8 million in 1990 to 113.4 million in 2015, a change of -31% (95% CI, -40% to -20%). Numbers are projected to decrease in all subregions except the subregions of sub-Saharan, Eastern, Middle, and Western Africa, which are expected to experience substantial increases in the number of underweight children., Conclusions: An overall improvement in the global situation is anticipated; however, neither the world as a whole, nor the developing regions, are expected to achieve the Millennium Development goals. This is largely due to the deteriorating situation in Africa where all subregions, except Northern Africa, are expected to fail to meet the goal.
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- 2004
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410. Intermittent iron supplementation regimens are able to maintain safe maternal hemoglobin concentrations during pregnancy in Venezuela.
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Pena-Rosas JP, Nesheim MC, Garcia-Casal MN, Crompton DW, Sanjur D, Viteri FE, Frongillo EA, and Lorenzana P
- Subjects
- Administration, Oral, Diet, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Folic Acid administration & dosage, Helminthiasis diagnosis, Helminthiasis physiopathology, Humans, Osmolar Concentration, Patient Compliance, Severity of Illness Index, Venezuela, Dietary Supplements, Hemoglobins analysis, Intestines parasitology, Iron administration & dosage, Pregnancy blood
- Abstract
Daily iron supplementation programs for pregnant women recommend amounts of iron that are considered by some to be excessive, and either lower-dose or less frequent iron supplementation regimens have been proposed. A randomized, placebo-controlled study was performed to assess and compare the relative effectiveness of a weekly (WS) or twice weekly (TW) iron supplementation schedule in maintaining or achieving hemoglobin (Hb) levels at term considered to carry minimal maternal and fetal risk (90-130 g/L). Pregnant women (n = 116) at wk 10-30 of gestation (63 WS and 53 TW) were enrolled in the study (52 in WS and 44 TW completed the study). Women were randomly allocated to receive a 120-mg oral dose of iron as ferrous sulfate and 0.5 mg of folic acid weekly (n = 52) or 60 mg iron and 0.25 mg folic acid and a placebo twice weekly (n = 44). Hb, hematocrit, serum ferritin, and transferrin saturation were estimated at baseline and at 36-39 wk of gestation. Baseline dietary data and the presence and intensity of intestinal helminthic infections were assessed. The duration of supplementation was 14 +/- 4 wk and the median level of adherence was 60.5%. Hb concentrations improved in women following the TW regimen and in women following WS who had low baseline Hb levels. About 89% of WS women and 95% of TW women maintained Hb levels at term (between 90 g/L and 130 g/L), a range associated with optimal pregnancy outcomes. One woman in the TW group exhibited higher Hb levels that potentially carried perinatal risk (>130 g/L). Intermittent iron and folic acid supplementation may be a valid strategy when used as a preventive intervention in prenatal care settings.
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- 2004
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411. The WHO Multicentre Growth Reference Study: planning, study design, and methodology.
- Author
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de Onis M, Garza C, Victora CG, Onyango AW, Frongillo EA, and Martines J
- Subjects
- Anthropometry, Brazil, Child, Child, Preschool, Cross-Sectional Studies, Follow-Up Studies, Ghana, Growth and Development, Humans, India, Infant, Infant, Newborn, Longitudinal Studies, Norway, Oman, Psychomotor Performance, Reference Standards, Research Design, United States, World Health Organization, Child Development physiology, Child Welfare, Infant Welfare, Multicenter Studies as Topic
- Abstract
The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) is a community-based, multicountry project to develop new growth references for infants and young children. The design combines a longitudinal study from birth to 24 months with a cross-sectional study of children aged 18 to 71 months. The pooled sample from the six participating countries (Brazil, Ghana, India, Norway, Oman, and the United States) consists of about 8,500 children. The study subpopulations had socioeconomic conditions favorable to growth, and low mobility, with at least 20% of mothers following feeding recommendations and having access to breastfeeding support. The individual inclusion criteria were absence of health or environmental constraints on growth, adherence to MGRS feeding recommendations, absence of maternal smoking, single term birth, and absence of significant morbidity. In the longitudinal study, mothers and newborns were screened and enrolled at birth and visited at home 21 times: at weeks 1, 2, 4, and 6; monthly from 2 to 12 months; and every 2 months in their second year. In addition to the data collected on anthropometry and motor development, information was gathered on socioeconomic, demographic, and environmental characteristics, perinatal factors, morbidity, and feeding practices. The prescriptive approach taken is expected to provide a single international reference that represents the best description of physiological growth for all children under five years of age and to establish the breastfed infant as the normative model for growth and development.
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- 2004
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412. Understanding the experience of household food insecurity in rural Bangladesh leads to a measure different from that used in other countries.
- Author
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Frongillo EA, Chowdhury N, Ekström EC, and Naved RT
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- Adult, Bangladesh, Female, Humans, Interviews as Topic, Middle Aged, Surveys and Questionnaires, Anxiety psychology, Family Characteristics, Food Supply, Rural Population
- Abstract
This research aimed to gain in-depth understanding of the experience of household food insecurity in rural Bangladesh and to develop a direct measure of it from this understanding. Using naturalistic, emergent inquiry, in-depth interviews were conducted with 21 rural women living in diverse situations using a semistructured interview guide. Two analytic strategies classified households on food insecurity and elicited themes that were the basis for classification. Survey questions were developed to capture themes, and were revised after review, field testing, and ranking and pile-sorting exercises. Four gradations of severity of food insecurity resulted, based on nine themes: meals, cooking, rice, fish, perishable foods, snacks, festival food, other expenditures and management strategies. The emergent conceptualization of food insecurity differs from that found from naturalistic research in other countries. The developed food insecurity measure has 11 questions. This research affirms the value of gaining in-depth understanding of household food insecurity. In many situations, this approach, rather than translating questions developed elsewhere, may best lead to suitable experience-based measures of food insecurity.
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- 2003
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413. Understanding the experience of food insecurity by elders suggests ways to improve its measurement.
- Author
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Wolfe WS, Frongillo EA, and Valois P
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- Aged, Cooking, Costs and Cost Analysis, Female, Food economics, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Interviews as Topic, Male, Research Design, Social Perception, Aging psychology, Food Supply, Hunger
- Abstract
A full conceptualization of the elderly food insecurity experience has been lacking, leading to limitations in the definition and measurement of food insecurity in elders. Based on the qualitative analysis of two in-depth interviews 6 mo apart with each of 53 low income urban elders, using principles of grounded theory, the experience of elderly food insecurity was shown to have four components: quantitative, qualitative, psychological and social. The inability to obtain the right foods for health is a new element specific to elders. Common to each of these components were dimensions of severity, time and compromised food choice. Although money is a major cause of food insecurity, elders sometimes have enough money for food but are not able to access food because of transportation or functional limitations, or are not able to use food (i.e., not able to prepare or eat available food) because of functional impairments and health problems. These findings suggest that augmentation of the U.S. Household Food Security Survey Module (FSSM), a national measure of food insecurity based on research in younger persons, may result in more accurate assessments for elders. We developed 14 new items for possible augmentation and administered them by telephone to these same elders along with the FSSM. Elders were independently classified according to food insecurity status based on their experience from the in-depth interviews, and these definitive criteria were used to evaluate the new and existing items. The results suggest that "couldn't afford right foods for health" and two policy-relevant immediate causes, "couldn't get the food I needed" and possibly "unable to prepare," should be added, although further testing is needed.
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- 2003
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414. Commentary: Assessing food insecurity in Trinidad and Tobago.
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Frongillo EA
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- Adolescent, Adult, Choice Behavior, Female, Food Deprivation, Food Supply, Fruit, Humans, Socioeconomic Factors, Trinidad and Tobago, United States, Vegetables, Diet, Food
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- 2003
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415. Secular trend in age at menarche for South Korean women born between 1920 and 1986: the Ansan Study.
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Hwang JY, Shin C, Frongillo EA, Shin KR, and Jo I
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- Adolescent, Adult, Age Factors, Aged, Cohort Studies, Female, Humans, Korea epidemiology, Middle Aged, Retrospective Studies, Body Height ethnology, Body Height physiology, Menarche ethnology, Menarche physiology, Population Dynamics
- Abstract
Background: There is strong evidence of a downward secular trend in age at menarche in Europe and the USA during the last century and in Japan and China during the past few decades. However, no study on this trend in age at menarche has been reported in South Korea., Aim: To measure the trend in age at menarche in South Korea during the past few decades and the association of height with this trend., Subjects and Methods: A total of 1061 South Korean women born between 1920 and 1986 were randomly recruited from Ansan Cohort Study samples and separate school girl samples, and subjected to this analysis. The data on age at menarche were collected by the retrospective method. Height was measured at time studied and assumed to be relatively constant since age at menarche. Women were grouped with respect to decade of birth and mean age at menarche was determined. The secular trends in annual age at menarche and in height were analysed by the 3-year moving average., Results: Mean menarcheal age decreased from 16.8 to 12.7 years during the past 67 years, corresponding to -0.64 years per decade. Height increased from 149.23 to 161.75 cm during the same period, showing an inverse relationship in the change of trend between height and mean age at menarche., Conclusion: Our data suggest that the downward secular trend in age at menarche may reflect the secular change in physical growth in South Korean women during the past 67 years.
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- 2003
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416. Understanding obesity and program participation in the context of poverty and food insecurity.
- Author
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Frongillo EA
- Subjects
- Humans, Obesity diet therapy, Obesity prevention & control, Food Supply, Obesity epidemiology, Poverty
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- 2003
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417. Integrated program enhancements increased utilization of Farmers' Market Nutrition Program.
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Conrey EJ, Frongillo EA, Dollahite JS, and Griffin MR
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- Child, Preschool, Female, Humans, Infant, New York, Program Evaluation, Agriculture, Food Supply, Government Programs, Health Planning, Health Promotion
- Abstract
Three New York State agencies undertook a state-wide initiative in 2001 to enhance the effectiveness of the Special Supplemental Program for Women, Infants, and Children (WIC) Farmers' Market Nutrition Program (FMNP) for both families and farmers. The program enhancements included four components intended to influence market and consumer behavior: hiring a state-wide Cornell Cooperative Extension staff member to initiate and coordinate FMNP promotion efforts; increased collaboration among state-level agencies; local-level community capacity-building; and dissemination of newly developed nutrition education resources. Because components were overlapping and potentially synergistic, the total effect was considered. To test the hypothesis that the enhancements increased Program utilization as measured by redemption rates, a time-series, quasi-experimental design was employed in which observed 2001 redemption was tested for departure from earlier trends. Linear regression showed FMNP coupon redemption rates from 1996 through 2000 decreased 2.36% annually (P = 0.002). This trend was interrupted in 2001 when actual redemption exceeded predicted redemption by >2.2% (P < 0.055). Alternate explanations for this shift were deemed improbable. These findings show that FMNP goals were advanced through a coordinated, collaborative initiative with activities at state and local levels, resulting in increased utilization of FMNP benefits by WIC participants and increased income to local farmers.
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- 2003
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418. Randomized efficacy trial of a micronutrient-fortified beverage in primary school children in Tanzania.
- Author
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Ash DM, Tatala SR, Frongillo EA Jr, Ndossi GD, and Latham MC
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- Anemia, Iron-Deficiency drug therapy, Anemia, Iron-Deficiency epidemiology, Anemia, Iron-Deficiency prevention & control, Body Height, Body Mass Index, Body Weight, Child, Double-Blind Method, Female, Ferritins blood, Food, Fortified, Hemoglobins analysis, Humans, Male, Parasitic Diseases complications, Parasitic Diseases drug therapy, Placebos, Schools, Tanzania epidemiology, Vitamin A blood, Vitamin A Deficiency drug therapy, Vitamin A Deficiency epidemiology, Vitamin A Deficiency prevention & control, Beverages, Micronutrients administration & dosage
- Abstract
Background: Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies., Objective: We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children (aged 6-11 y) attending primary schools., Design: In this randomized, double-blind, placebo-controlled efficacy trial, children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo., Results: There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status, serum retinol, and anthropometry. At the 6-mo follow-up, among children with anemia (hemoglobin < 110 g/L), there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group (9.2 and 0.2 g/L, respectively). Of those who were anemic at baseline, 69.4% in the nonfortified group and 55.1% in the fortified group remained anemic at follow-up (RR: 0.79), a cure rate of 21%. The prevalence of children with low serum retinol concentrations (< 200 microg/L) dropped significantly from 21.4% to 11.3% in the fortified group compared with a nonsignificant change (20.6% to 19.7%) in the nonfortified group. At follow-up, mean incremental changes in weight (1.79 compared with 1.24 kg), height (3.2 compared with 2.6 cm), and BMI (0.88 compared with 0.53) were significantly higher in the fortified group than in the nonfortified group., Conclusion: The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A deficiency.
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- 2003
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419. Marital status changes and body weight changes: a US longitudinal analysis.
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Sobal J, Rauschenbach B, and Frongillo EA
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- Adolescent, Adult, Aged, Behavior, Female, Health Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Nutrition Surveys, Psychometrics, Role, Sociometric Techniques, United States epidemiology, Weight Gain, Weight Loss, Body Weight physiology, Marital Status
- Abstract
The role of spouse is associated with better health. The dynamics of spousal roles can be represented by marital trajectories that may remain stable or may change by entry into marriage, dissolution of marriage, or death of a spouse. Body weight is an important health-related characteristic that has been found to have mixed relationships with marital status. This analysis examined changes in marital status and body weight in 9043 adults in the US National Health and Nutrition Epidemiological Follow-up Survey (NHEFS), a longitudinal national study that interviewed and measured adults in a baseline assessment and reassessed them again in a follow-up approximately 10 years later. Men's and women's weights were differently associated with marital changes. Women who were unmarried at baseline and married at follow-up had greater weight change than those who were married at both times. Analysis of weight loss and weight gain separately revealed that sociodemographic variables, including marital change, were more predictive of variation in weight loss than weight gain. Unmarried women who married gained more weight than women married at both times. Men who remained divorced/separated and men who became widowed lost more weight than men married at both baseline and follow-up. These findings suggest that changes in social roles, such as entering or leaving marriage, influence physical characteristics such as body weight.
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- 2003
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420. Changes in child survival are strongly associated with changes in malnutrition in developing countries.
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Pelletier DL and Frongillo EA
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- Child, Preschool, Humans, Infant, Infant, Newborn, Longitudinal Studies, Nutrition Disorders mortality, Prevalence, Developing Countries, Infant Mortality trends, Nutrition Disorders epidemiology
- Abstract
Considerable evidence suggests that malnutrition affects human performance, health and survival, including physical growth, morbidity, mortality, cognitive development, reproduction, physical work capacity and risks for several adult-onset chronic diseases. In recent decades, development agencies and governments have emphasized selective interventions to improve health and nutritional status, such as immunizations, oral rehydration, antibiotics and micronutrients, with child survival as a major motivation and justification. Although the efficacy of these approaches for improving child survival has been amenable to study, providing some of the rationale for using these approaches, it has not been possible to test directly the effects of improvements in general malnutrition. The present study quantified the effects of changes in general malnutrition, as measured by child weight-for-age (WA), on changes in child survival in 59 developing countries, using aggregate, longitudinal data at national and subnational levels from 1966 to 1996. Mixed model analysis (in SAS) was used, to take advantage of the multilevel and longitudinal nature of these data sets. Changes in WA have a statistically significant effect on changes in child mortality, independent of socioeconomic and policy changes represented by the secular trend. The secular trend in mortality began earlier and leveled off at higher mortality rates in populations with a higher prevalence of malnutrition. Gaps in coverage of selective interventions are more likely and more serious in the more malnourished populations. Continued reduction in mortality will require improved targeting of selective interventions and general nutritional improvement to the most marginal populations.
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- 2003
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421. Academic performance of Korean children is associated with dietary behaviours and physical status.
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Kim HY, Frongillo EA, Han SS, Oh SY, Kim WK, Jang YA, Won HS, Lee HS, and Kim SH
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- Adolescent, Body Height, Body Weight, Child, Female, Humans, Korea, Male, Social Class, Surveys and Questionnaires, Educational Measurement, Feeding Behavior, Physical Fitness
- Abstract
The purpose of this study was to obtain a fuller understanding of the association of dietary behaviours, physical status and socio-economic status with academic performance in Korean teenagers. The subjects in this study were 6,463 boys and girls, in grade 5, 8, and 11 in Korea. A self-administered questionnaire and the food-frequency form were used. Grade point average (GPA), height, weight, and physical fitness score for the year were recorded from the school record. The academic performance of students was strongly associated with dietary behaviours, especially with regularity of three meals even after control for parent's education level. Regular breakfast and lunch were more important in grades 5 and 8, while regular dinner was more related with academic performance in grade 11. Small, positive associations of height and physical fitness to academic performance were also found. The relative importance of regularity of meals was greater than that of socio-economic status and physical status in older teenagers. The results of this study suggest that accommodation of better dietary environment and nutrition education for three regular meals is recommended.
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- 2003
422. Vitamin B6 status of children with sickle cell disease.
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Nelson MC, Zemel BS, Kawchak DA, Barden EM, Frongillo EA Jr, Coburn SP, Ohene-Frempong K, and Stallings VA
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- Adolescent, Adult, Alanine Transaminase metabolism, Alkaline Phosphatase metabolism, Anemia, Sickle Cell epidemiology, Anthropometry, Aspartate Aminotransferases metabolism, Biomarkers analysis, Child, Child, Preschool, Diet, Female, Humans, Longitudinal Studies, Male, Philadelphia epidemiology, Pyridoxal Phosphate blood, Pyridoxic Acid urine, Anemia, Sickle Cell metabolism, Child Nutritional Physiological Phenomena, Nutritional Status, Vitamin B 6 metabolism
- Abstract
Purpose: In vitro, vitamin B(6) has antisickling properties, but the effect of vitamin B status on the health of children with sickle cell disease-SS (SCD-SS) is not well described. The purpose of this study was to assess vitamin B(6) status of children with SCD-SS ages 3 to 20 years and determine its relationship to growth, dietary intake, and disease severity., Patients and Methods: Vitamin B(6) status was assessed by serum pyridoxal 5-phosphate (PLP) concentration in subjects with SCD-SS and by urinary 4-pyridoxic acid (4-PA) concentration in other subjects with SCD-SS and healthy control children. Concentration of PLP was compared with anthropometric measures of growth and nutritional status, dietary intake, hematologic indices, and frequency of SCD-related illness., Results: The PLP concentration of subjects with SCD-SS was 15.6 +/- 15.2 nmol/L. Seventy-seven percent had a PLP concentration below the deficiency criterion (20 nmol/L) suggested by the Dietary Reference Intakes (1998). Controlling for alkaline phosphatase, age, and gender, PLP concentration was associated positively with weight, body mass index, and arm circumference -scores and negatively with reticulocyte count. Urinary 4-PA was lower in children with SCD-SS versus controls, although 4-PA/creatinine values did not differ between groups., Conclusions: Children with SCD-SS had apparently low serum PLP concentrations in the absence of excess vitamin B(6) excretion, suggesting low vitamin B(6) status. Low serum PLP concentration was associated with indicators of poor nutritional status and may be related to increased hemolysis in children with SCD-SS.
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- 2002
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423. Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents.
- Author
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Alaimo K, Olson CM, and Frongillo EA
- Subjects
- Adolescent, Dysthymic Disorder etiology, Family, Female, Humans, Income, Male, Nutrition Surveys, Prevalence, Sex Distribution, United States epidemiology, Dysthymic Disorder epidemiology, Hunger, Suicide, Attempted statistics & numerical data
- Abstract
Food insufficiency has been shown to be associated with poor health, academic and psychosocial outcomes in American children, but the relationship between food insufficiency and depressive disorders in U.S. adolescents has not been studied. Further, there are no national estimates of the prevalence of depressive disorders for U.S. adolescents, nor investigation of associations with sociodemographic characteristics using national data. Therefore, we analyzed data for 15- and 16-y-old adolescents from the Third National Health and Nutrition Examination Survey (NHANES III). Depressive disorders and suicidal symptoms were assessed using the Diagnostic Interview Schedule. Adolescents were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not have enough to eat. The prevalence of depression outcomes is reported by sociodemographic characteristics. Odds ratios for associations with food insufficiency are reported, adjusted for sociodemographic factors. Overall, lifetime prevalence of major depressive disorder was 6.3% and of dysthymia, 5.4%. Almost 5% of 15- to 16-y-old adolescents reported that they had ever attempted suicide and 38.8% reported at least one suicidal symptom. Female adolescents were significantly more likely than males to have had dysthymia, any depressive disorder and all symptoms of suicide. Low income adolescents were less likely to report suicide ideation than high income adolescents, but there were no other differences by family income. Food-insufficient adolescents were significantly more likely to have had dysthymia, thoughts of death, a desire to die and have attempted suicide. There is a strong association between food insufficiency and depressive disorder and suicidal symptoms in U.S. adolescents.
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- 2002
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424. Evaluation of psychosocial measures for understanding weight-related behaviors in pregnant women.
- Author
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Kendall A, Olson CM, and Frongillo EA Jr
- Subjects
- Adolescent, Adult, Body Image, Employment, Factor Analysis, Statistical, Female, Humans, Internal-External Control, Middle Aged, New York, Obesity prevention & control, Obesity psychology, Poverty, Reproducibility of Results, Rural Population, Self Efficacy, Exercise psychology, Feeding Behavior psychology, Pregnancy psychology, Psychological Tests, Weight Gain
- Abstract
The greatest weight gain for US. women occurs during the childbearing years of 25 to 34, and many obese women attribute their adult weight gain to childbearing. Few studies have examined psychosocial influences on women's behaviors during pregnancy, in part because of the lack of valid and reliable measures of psychosocial constructs relevant to pregnant women. Based on existing theory and an in-depth interview study, the psychosocial constructs of locus of control, self-efficacy, body image, feelings about motherhood, and career orientation were identified. Scales for each construct were constructed by drawing items from existing validated scales and writing items based on the in-depth interviews; their content validity assessed using factor analysis with oblique rotation and their reliability using Cronbach's alpha. Construct validity was assessed by examining the associations between scale scores and preexisting conditions of participants. Data for evaluating the scales came from a study of 622 pregnant women in a rural health care system who completed questionnaires and whose medical records were audited. Cronbach's alpha of the scales ranged from 0.73 to 0.89. Scale scores were strongly associated with lifestyle behaviors, body weight, and demographic characteristics of the participants. The analysis provides evidence of the validity of measures of psychosocial factors related to health behaviors of pregnant women. These measures should be useful in studying weight-related behaviors in pregnant women.
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- 2001
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425. Low family income and food insufficiency in relation to overweight in US children: is there a paradox?
- Author
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Alaimo K, Olson CM, and Frongillo EA Jr
- Subjects
- Adolescent, Age Distribution, Child, Child, Preschool, Cross-Sectional Studies, Ethnicity statistics & numerical data, Female, Humans, Income, Logistic Models, Male, Models, Theoretical, Prevalence, Sex Distribution, United States, Child Nutritional Physiological Phenomena, Hunger, Obesity epidemiology, Poverty
- Abstract
Objectives: To investigate associations between family income, food insufficiency, and being overweight in US children aged 2 to 7 and 8 to 16 years, to discuss mechanisms that may explain these associations, and to propose design and data requirements for further research that could effectively examine this issue., Methods: Data from the Third National Health and Nutrition Examination Survey were analyzed. Children were classified as food insufficient if the family respondents reported that their family sometimes or often did not get enough food to eat. The prevalence of overweight was compared by family income category and food sufficiency status within age-, sex-, and race-ethnic-specific groups. Odds ratios for food insufficiency are reported, adjusted for family income and other potential confounding factors., Results: Among older non-Hispanic white children, children in families with low income were significantly more likely to be overweight than children in families with high income. There were no significant differences by family income for younger non-Hispanic white children, non-Hispanic black children, or Mexican American children. After adjusting for confounding variables, there were no differences in overweight by food sufficiency status, except that younger food-insufficient girls were less likely to be overweight, and non-Hispanic white older food-insufficient girls were more likely to be overweight than food-sufficient girls (P<.10)., Conclusion: Further research to evaluate whether food insecurity causes overweight in American children requires longitudinal quantitative and in-depth qualitative methods.
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- 2001
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426. Household food insecurity was prevalent in Java during Indonesia's economic crisis.
- Author
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Studdert LJ, Frongillo EA Jr, and Valois P
- Subjects
- Adult, Anxiety etiology, Data Collection, Female, Humans, Indonesia epidemiology, Prevalence, Anxiety epidemiology, Diet, Food Supply economics
- Abstract
Valid assessment of household food security is important, particularly in rapidly changing circumstances such as the economic crisis that struck Indonesia in 1998. The Cornell-Radimer tool for measuring household food security has now been used in several social and economic settings. An adaptation of this tool was used in the context of the economic crisis of Java, Indonesia in June-August 1998 in a survey of 1423 mothers with children < 5 y old. Qualitative and quantitative data contributed to understanding food insecurity and provided evidence for some aspects of validity. The data showed substantial household food insecurity with 94.2% of households found to be uncertain or insecure about their food situation in the previous year. Of respondents, 11% reported losing weight in the previous year because of lack of food. Food security in Java was undoubtedly compromised by the economic crisis. These results suggest, on the basis of qualitative and quantitative understandings of food insecurity, that this tool provided a useful measure of the situation in Java in 1998. From this study and others done recently, such a tool or ones constructed using a similar approach have been found to be useful in various settings in which there is a need to understand and identify household food insecurity for purposes of estimating and monitoring prevalence and targeting of policies and programs. Further research to validate this approach in various settings is warranted.
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- 2001
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427. Child factor in measurement dependability.
- Author
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Lampl M, Birch L, Picciano MF, Johnson ML, and Frongillo EA Jr
- Subjects
- Analysis of Variance, Data Interpretation, Statistical, Humans, Infant, Longitudinal Studies, Research Design, Time Factors, Anthropometry methods, Bias, Body Height physiology, Child Development physiology, Growth
- Abstract
A primary consideration in longitudinal growth studies is the identification of growth from error components. While previous research has considered matters of measurement accuracy and reproducibility in detail, few reports have investigated the errors of measurement due to aspects of the physiology and cooperation of the child. The present study directly assesses this source of measurement undependability for the first time. Investigation of total measurement error variance in 925 recumbent length replicates taken over stasis intervals in growth identifies that between 60% and 70% of total measurement unreliability is due to a child factor undependability. Individual differences are significant and longitudinal growth analyses should consider two to three times the technical error of measurement statistic as a reasonable estimate of the total unreliability for any single measurement of an infant's recumbent length. These results raise issues regarding analytic methods as applied to serial growth data.
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- 2001
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428. Mixed distribution analysis identifies saltation and stasis growth.
- Author
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Lampl M, Johnson ML, and Frongillo EA Jr
- Subjects
- Body Height physiology, Humans, Infant, Likelihood Functions, Normal Distribution, Biometry, Child Development physiology
- Abstract
A maximum likelihood method of mixed distribution analysis is investigated for its utility as a method for the identification of saltation and stasis in longitudinal growth data. Daily infant growth data that have been previously identified to follow a saltatory growth process are employed. This is a novel application of the finite mixed distribution analysis (MDA), a method designed to objectively identify the presence of one or more Gaussian populations. The null hypothesis is that a single Gaussian distribution best describes the incremental growth data. This would be compatible with smooth, slowly varying daily growth patterns. This study explores whether or not two distinctive populations are evident in incremental saltatory growth data, as postulated by the saltation and stasis observations. The analysis is important in providing a growth model-independent test for the presence of saltation and stasis by a separate statistical assessment with none of the saltatory algorithm assumptions. The finite mixed distribution analysis identifies that each individual's incremental growth data is statistically best described as a mixture consisting of two components, or two populations of increments (chi-square, p < 0.05). For each individual, one of these populations is centred about a zero increment, and is compatible with the previous evidence of stasis intervals. The second population of data points is characterized by unique distributions for each individual, compatible with the previous observation that infants grow by unique patterns of growth saltations in both amplitude and frequency. The percentage of data points that fall within each of the two unique finite mixture distributions (FMDs) is similar to the proportions of discrete saltation and stasis intervals previously identified by the saltation and stasis method. Thus, the FMD analysis lends support to the nature of growth as a saltatory process characterized by two states in the daily growth of these infants. By contrast with the saltatory algorithm, which is applied to the original serial growth measurements, the mixed distribution analysis employs increments removed from their time relationships. The lack of time series sequence information precludes the mixed distribution method from reconstructing specific temporal patterns of saltatory growth. The present analysis reiterates that individual growth patterns are statistically unique and cannot be reconstructed or identified from group data.
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- 2001
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429. Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in U.S. women.
- Author
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Weinstein SJ, Ziegler RG, Frongillo EA Jr, Colman N, Sauberlich HE, Brinton LA, Hamman RF, Levine RS, Mallin K, Stolley PD, and Bisogni CA
- Subjects
- Adenocarcinoma epidemiology, Adenocarcinoma etiology, Adenocarcinoma pathology, Adult, Aged, Antibodies, Viral blood, Bacteriological Techniques, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell etiology, Carcinoma, Squamous Cell pathology, Case-Control Studies, Erythrocytes chemistry, Female, Humans, Interviews as Topic, Middle Aged, Neoplasm Invasiveness, Odds Ratio, Papillomaviridae immunology, Papillomavirus Infections blood, Papillomavirus Infections complications, Regression Analysis, Risk Factors, Tumor Virus Infections blood, Tumor Virus Infections complications, United States epidemiology, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms etiology, Uterine Cervical Neoplasms pathology, Adenocarcinoma blood, Carcinoma, Squamous Cell blood, Folic Acid blood, Uterine Cervical Neoplasms blood
- Abstract
Previous observational epidemiologic studies of folate and cervical cancer, as well as folate supplementation trials for cervical dysplasia, have produced mixed results. We examined the relationship between serum and RBC folate and incident invasive cervical cancer in a large, multicenter, community-based case-control study. Detailed in-person interviews were conducted, and blood was drawn at least 6 mo after completion of cancer treatment from 51% of cases and 68% of controls who were interviewed. Blood folate was measured with both microbiologic and radiobinding assays. Included in the final analyses were 183 cases and 540 controls. Logistic regression was used to control for all accepted risk factors, including age, sexual behavior, smoking, oral contraceptive use, Papanicolaou smear history and human papillomavirus (HPV)-16 serology. For all four folate measures, the geometric mean in cases was lower than in controls (e.g., 11.6 vs. 13.0 nmol/L, P < 0.01 for the serum radiobinding assay). Folate measures using microbiologic and radiobinding assays were correlated (serum: r = 0.90; RBC: r = 0.77). For serum folate, multivariate-adjusted odds ratios (OR) in the lowest vs. highest quartile were 1.3 [95% confidence interval (CI) = 0.8--2.9] and 1.6 (0.9--2.9), using the microbiologic and radiobinding assays, respectively. For RBC folate, comparable OR were 1.2 (0.6--2.2) and 1.5 (0.8--2.7). Similar risks were obtained when restricting analyses to subjects with a history of HPV infection. Thus, low serum and RBC folate were each moderately, but nonsignificantly, associated with increased invasive cervical cancer risk. These findings support a role for one-carbon metabolism in the etiology of cervical cancer.
- Published
- 2001
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430. Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development.
- Author
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Alaimo K, Olson CM, and Frongillo EA Jr
- Subjects
- Adolescent, Child, Female, Humans, Male, Nutrition Surveys, Regression Analysis, United States, Child Development, Cognition, Food, Learning, Poverty
- Abstract
Objective: This study investigates associations between food insufficiency and cognitive, academic, and psychosocial outcomes for US children and teenagers ages 6 to 11 and 12 to 16 years., Methods: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were analyzed. Children were classified as food-insufficient if the family respondent reported that his or her family sometimes or often did not get enough food to eat. Regression analyses were conducted to test for associations between food insufficiency and cognitive, academic, and psychosocial measures in general and then within lower-risk and higher-risk groups. Regression coefficients and odds ratios for food insufficiency are reported, adjusted for poverty status and other potential confounding factors., Results: After adjusting for confounding variables, 6- to 11-year-old food-insufficient children had significantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist, and have had difficulty getting along with other children. Food-insufficient teenagers were more likely to have seen a psychologist, have been suspended from school, and have had difficulty getting along with other children. Further analyses divided children into lower-risk and higher-risk groups. The associations between food insufficiency and children's outcomes varied by level of risk., Conclusions: The results demonstrate that negative academic and psychosocial outcomes are associated with family-level food insufficiency and provide support for public health efforts to increase the food security of American families.
- Published
- 2001
431. Nutritional and health consequences are associated with food insecurity among U.S. elderly persons.
- Author
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Lee JS and Frongillo EA Jr
- Subjects
- Activities of Daily Living, Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Middle Aged, United States, Diet psychology, Health Status
- Abstract
The purpose of this study was to examine the consequences associated with food insecurity for the nutritional and health status of the elderly in the United STATES: The data analyzed were from the Third National Health and Nutrition Examination Survey (1988-1994) and the Nutrition Survey of the Elderly in New York State (1994). Multiple logistic and linear regression analyses were used to assess the extent to which food-insecure elderly were likely to have lower nutrient intake, skinfold thickness, self-reported health status and higher nutritional risk. Regardless of food insecurity status, older people consumed less than the recommended dietary allowance for eight nutrients. Food-insecure elderly persons had significantly lower intakes of energy, protein, carbohydrate, saturated fat, niacin, riboflavin, vitamins B-6 and B-12, magnesium, iron and zinc, as well as lower skinfold thickness. In addition, food-insecure elderly persons were 2.33 (95% confidence interval: 1.73-3.14) times more likely to report fair/poor health status and had higher nutritional risk. These results indicate that food-insecure elderly persons have poorer dietary intake, nutritional status and health status than do food-secure elderly persons. It is necessary to ensure the nutritional well-being of all elderly persons who are at nutritional and health risk, including those who are food insecure and have even poorer nutritional and health status than those who are food secure.
- Published
- 2001
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432. Food insufficiency, family income, and health in US preschool and school-aged children.
- Author
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Alaimo K, Olson CM, Frongillo EA Jr, and Briefel RR
- Subjects
- Adolescent, Child, Child, Preschool, Ethnicity statistics & numerical data, Health Status Indicators, Humans, Odds Ratio, Poverty, Risk, United States, Child Welfare, Hunger, Income
- Abstract
Objectives: This study investigated associations between family income, food insufficiency, and health among US preschool and school-aged children., Methods: Data from the third National Health and Nutrition Examination Survey were analyzed. Children were classified as food insufficient if the family respondent reported that the family sometimes or often did not get enough food to eat. Regression analyses were conducted with health measures as the outcome variables. Prevalence rates of health variables were compared by family income category, with control for age and gender. Odds ratios for food insufficiency were calculated with control for family income and other potential confounding factors., Results: Low-income children had a higher prevalence of poor/fair health status and iron deficiency than high-income children. After confounding factors, including poverty status, had been controlled, food-insufficient children were significantly more likely to have poorer health status and to experience more frequent stomachaches and headaches than food-sufficient children; preschool food-insufficient children had more frequent colds., Conclusions: Food insufficiency and low family income are health concerns for US preschool and school-aged children.
- Published
- 2001
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433. Factors associated with food insecurity among U.S. elderly persons: importance of functional impairments.
- Author
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Lee JS and Frongillo EA Jr
- Subjects
- Aged, 80 and over, Female, Health Services for the Aged standards, Health Services for the Aged supply & distribution, Health Status, Humans, Male, Middle Aged, Nutritional Status, Socioeconomic Factors, Aged psychology, Attitude, Cognition Disorders diagnosis, Food
- Abstract
Objectives: The authors examined factors associated with the food insecurity of elderly persons in the United States and particularly how functional impairments were associated with food insecurity., Methods: Data were from the Third National Health and Nutrition Examination Survey (1988-94) and the Nutrition Survey of the Elderly in New York State (1994). The authors used multiple logistic regression and a hierarchical logistic regression analyses to examine how functional impairments as well as sociodemographic and economic factors contributed to food insecurity in elderly persons., Results: Low income, low education, minority status, food assistance program participation, and social isolation were significantly related with food insecurity. Functional impairments were significantly related with food insecurity among elderly persons even after those factors were controlled., Discussion: Food security in elderly persons is associated with functional impairments, suggesting that food insecurity in elderly persons comprises not only limited food affordability, availability, and accessibility but also altered food use. Food-insecure elderly persons experience multiple problems that prevent them from achieving nutritional well-being and seeking food assistance programs. Nutrition services should recognize and provide services to cover those needs.
- Published
- 2001
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434. Understanding needs is important for assessing the impact of food assistance program participation on nutritional and health status in U.S. elderly persons.
- Author
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Lee JS and Frongillo EA Jr
- Subjects
- Aged, Aged, 80 and over, Aging, Anthropometry, Cross-Sectional Studies, Epidemiologic Research Design, Female, Humans, Longitudinal Studies, Male, Nutrition Assessment, Nutrition Surveys, Nutritional Status, Outcome Assessment, Health Care statistics & numerical data, Program Evaluation, Regression Analysis, United States epidemiology, Food Services statistics & numerical data, Health Services Needs and Demand, Health Services for the Aged statistics & numerical data, Health Status, National Health Programs
- Abstract
This study aimed to assess the impact of food assistance programs on nutritional and health status of nutritionally needy elderly persons. Two cross-sectional and one longitudinal data sets were used: Third National Health and Nutrition Examination Survey (1988-94), Nutrition Survey of the Elderly in New York State (1994) and Longitudinal Study of Aging (1984-1990). Multiple logistic and linear regression analyses were used to examine whether food assistance participants among food insecure elderly (i.e., those whose needs for food assistance programs are met) have better nutrient intake, skinfold thickness and self-reported health status and less nutritional risk, hospitalization and mortality than nonparticipants (i.e., those whose needs are unmet) and whether the benefit is larger than that among food secure elderly persons. Across three data sets, food insecure elderly persons had poorer nutritional and health status than food secure elderly persons. Contrary to the hypotheses, among food insecure elderly persons, food assistance participants had similar or poorer nutrient intakes, skinfold thickness, nutritional risk, self-reported health status, hospitalization and mortality than nonparticipants. Food secure participants had similar nutritional and health status as food secure nonparticipants. Lack of information on the dynamic nature and changes in needs with program participation in the three data sets likely did not allow accurate estimation of the impact of food assistance participation. Different study designs, as well as theory and knowledge of needs that clarifies need status and its change within each older individual across an appropriate time interval, are necessary to accurately assess impacts of food assistance programs.
- Published
- 2001
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435. Evaluating brief measures of fruit and vegetable consumption frequency and variety: cognition, interpretation, and other measurement issues.
- Author
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Wolfe WS, Frongillo EA, and Cassano PA
- Subjects
- Feeding Behavior, Health Knowledge, Attitudes, Practice, Health Promotion, Humans, Interviews as Topic, Mental Recall, Nutrition Assessment, Reproducibility of Results, Black or African American psychology, Fruit, Hispanic or Latino psychology, Surveys and Questionnaires standards, Vegetables, White People psychology
- Abstract
To evaluate whether items from 3 brief measures of fruit and vegetable consumption were understood and interpreted as intended, cognitive testing was conducted in a purposive sample of 31 white, African-American and Hispanic persons. The measurement instruments tested were the fruit and vegetable module from the Behavioral Risk Factor Surveillance System (to measure frequency), and 1 fruit and 1 vegetable variety measurement instrument developed by the investigators. The cognitive testing interviews were analyzed qualitatively to identify interpretation difficulties and other measurement issues. The testing identified a number of measurement issues, including issues related to time frame, wording, interpretation, grouping of items, and serving size. Recommendations based on the findings were incorporated into revised versions of each instrument, which were further tested in a small sample. As revised and presented in this article, these instruments for assessing fruit and vegetable frequency and variety appear to be understood and interpreted as intended across different racial and ethnic groups, and may be useful in situations requiring brief dietary assessment, although further testing is needed.
- Published
- 2001
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436. Do social programmes contribute to mental well-being? The long-term impact of unemployment on depression in the United States.
- Author
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Rodriguez E, Frongillo EA, and Chandra P
- Subjects
- Family psychology, Female, Humans, Male, Regression Analysis, United States epidemiology, Depressive Disorder epidemiology, Social Welfare, Unemployment psychology
- Abstract
Background: Important evidence about the mental health effects of unemployment exist; however, little is known about the possible protective effects of various social interventions or about their long-term impact. This study examines the long-term consequences that different types of social programmes, i.e. entitlement and means-tested benefits, might have as regards ameliorating a negative mental health impact of unemployment among women and men., Methods: Multiple regression models were used to analyse panel data collected in the National Survey of Families and Households in 1987 and 1992. In all 8029 individuals interviewed in both 1987 and 1992 were included in the analysis. A depression index was created from the responses to 15 items from the Center for Epidemiological Studies' Depression Scale-D (CES-D) which were included in the survey., Results: The receipt of government entitlement benefits by unemployed women is associated with a reduction of depression symptoms in the long term. Men and women not working and receiving means-tested or welfare benefits are more likely to report depression in both the short and long term., Conclusions: The study underscores the need for monitoring the impact of welfare reform on mental health.
- Published
- 2001
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437. Acculturation and health in Korean Americans.
- Author
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Lee SK, Sobal J, and Frongillo EA Jr
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Body Weight, Cross-Sectional Studies, Female, Humans, Korea ethnology, Male, Middle Aged, Obesity ethnology, Odds Ratio, Regression Analysis, Socioeconomic Factors, United States epidemiology, Acculturation, Asian statistics & numerical data, Health Behavior ethnology, Health Status
- Abstract
Despite increasing research on the relationships between acculturation and health, it is unclear whether (1) ethnic group variation occurs in acculturation-health relationships, (2) acculturation components vary differently in relationship to health, (3) biculturalism has beneficial effects on health and (4) multidimensional health relationships occur with acculturation. This study examined the Korean American ethnic group, considering how acculturation was related with five dimensions of health: smoking, physical activity, fat intake, body weight, and reported health. Pretested questionnaires were mailed to a national sample with Korean American surnames, and 55% of the deliverable sample responded, producing 356 usable questionnaires. Acculturation was measured using a two-culture matrix model and Gordon's theoretical work, and showed three distinct groups (acculturated, bicultural and traditional) and four components (American structural, American cultural, Korean structural and Korean cultural). Bicultural men were least likely to smoke, while acculturated and bicultural women were more likely to smoke than traditional women. Korean structural and cultural components were related to men's smoking. Higher acculturation was related to light physical activity, but not to vigorous physical activity. Fat intake did not differ by acculturation status. Higher acculturation was associated with higher body weight and better self-reported health only in men. Higher American cultural component scores were associated with better self-reported health in men. Among Korean Americans, acculturation components varied in their relationships with health, beneficial effects of being bicultural on health were not found, and acculturation-health relationships were multidimensional. Overall, ethnic group variation in health occurred, with Korean Americans similar to some ethnic groups but different than others. Future health research and practice can benefit by acknowledging the complexity of acculturation and its multidimensional effects on health.
- Published
- 2000
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438. The Drosophila seminal fluid protein Acp26Aa stimulates release of oocytes by the ovary.
- Author
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Heifetz Y, Lung O, Frongillo EA Jr, and Wolfner MF
- Subjects
- Animals, Female, Intercellular Signaling Peptides and Proteins, Male, Drosophila Proteins, Drosophila melanogaster physiology, Ovulation physiology, Peptides physiology, Semen metabolism
- Abstract
Mating stimulates the rate of egg-laying by female insects. In Drosophila melanogaster this stimulation is initially caused by seminal fluid molecules transferred from the male (Acps or accessory gland proteins; reviewed in [1] [2] [3]). Egg-laying is a multi-step process. It begins with oocyte release by the ovaries, followed by egg movement down the oviducts and the deposition of eggs onto the substratum. Although two Acps are known to stimulate egg-laying [4] [5], they were detected by assays that do not discriminate between the steps of this process or allow examination of its earliest changes [4] [5] [6] [7]. To determine how egg-laying is regulated, we developed a generally applicable assay to separate the process into quantifiable steps, allowing us to assess the ovulation pattern and rate of egg movement. As the steps are interdependent yet potentially subject to independent controls, we determined the contribution of each step and effector independent of the others. We used a statistical method [8] [9] that separately considers and quantifies each 'path' to a common end. We found that the prohormone-like molecule Acp26Aa [5] [10] stimulates the first step in egg-laying - release of oocytes by the ovary. During mating, Acp26Aa begins to accumulate at the base of the ovaries, a position consistent with action on the ovarian musculature to mediate oocyte release. Understanding how individual Acps regulate egg-laying in fruitflies will help provide a full molecular picture of insects' prodigious fertility, of reproductive hormones, and of the roles of these rapidly evolving proteins [11] [12].
- Published
- 2000
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439. Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980.
- Author
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de Onis M, Frongillo EA, and Blössner M
- Subjects
- Child, Child, Preschool, Cross-Sectional Studies, Female, Growth Disorders etiology, Humans, Male, Nutrition Disorders complications, Child Welfare trends, Developing Countries statistics & numerical data, Growth Disorders epidemiology, Nutrition Disorders epidemiology
- Abstract
Nutritional status is the best global indicator of well-being in children. Although many surveys of children have been conducted since the 1970s, lack of comparability between them has made it difficult to monitor trends in child malnutrition. Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting). Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005. The prevalence of stunting has fallen in developing countries from 47% in 1980 to 33% in 2000 (i.e. by 40 million), although progress has been uneven according to regions. Stunting has increased in Eastern Africa, but decreased in South-eastern Asia, South-central Asia and South America; Northern Africa and the Caribbean show modest improvement; and Western Africa and Central America present very little progress. Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries. In some countries rates of stunting are rising, while in many others they remain disturbingly high. The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of populationwide interventions. Approaches to lower child malnutrition should be based on successful nutrition programmes and policies.
- Published
- 2000
440. Acculturation and dietary practices among Korean Americans.
- Author
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Lee SK, Sobal J, and Frongillo EA Jr
- Subjects
- Adult, Cross-Sectional Studies, Diet Surveys, Female, Humans, Korea ethnology, Male, Surveys and Questionnaires, Acculturation, Asian, Diet standards, Feeding Behavior ethnology
- Abstract
Objective: Examine variation in dietary practices and nutritional intakes of Korean Americans at different acculturation levels., Design: Cross-sectional mail survey., Subjects/setting: US national sample of 348 Korean Americans (46% of the Korean American sample to whom questionnaires were delivered)., Statistical Analysis Performed: Analysis of variance, Pearson correlation, Spearman rank correlation, chi 2 test, and multiple regression analysis., Results: Korean Americans who were more acculturated consumed more American food and less Korean food. American foods such as oranges, low-fat milk, bagels, tomatoes, and bread were consumed regularly by Korean Americans; Korean foods such as rice, kimchi, garlic, green onions, and Korean soup were also consumed regularly. American foods were adopted the most at breakfast and the least at dinner. Bicultural people regularly incorporated more different types of foods into their diet. Despite significant differences in dietary practices, dietary quality did not vary by acculturation status., Application/conclusions: Acculturation was influential in the dietary patterns of Korean Americans. Specific information about Korean diet related to acculturation status can be used by dietitians who work with Korean Americans. Dietitians can benefit from gathering and applying specific information about Korean diets and diets of other ethnic groups; they also need to recognize the changing nature of dietary patterns as acculturation occurs.
- Published
- 1999
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441. Unemployment, depression, and health: a look at the African-American community.
- Author
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Rodriguez E, Allen JA, Frongillo EA Jr, and Chandra P
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Income, Logistic Models, Male, Middle Aged, Poverty, Regression Analysis, Social Class, Social Security, United States epidemiology, White People statistics & numerical data, Black or African American statistics & numerical data, Depression epidemiology, Health Status, Unemployment statistics & numerical data
- Abstract
Objectives: While the unemployment rate of African-American people is more than twice that of the white population, the research on the impact of unemployment on the health of this population is scarce. This study analysed the impact of unemployment on depression and well being among African-American people, and the factors associated with well being., Methods: Logistic and multiple regression models were used to analyse panel data collected in the National Survey of Families and Households 1987-1992. African-American (1369) and white (6660) respondents were analysed separately. Outcome variables included an index of depression and self reported health status., Main Findings: Differences between employment and unemployment groups were less significant for African-Americans than for the white population in predicting depression and well being. Health enhancing factors such as education and wealth were significantly associated with better health and lower depression indices among the white population but not consistently so among African-Americans. Satisfaction with personal relationships was the strongest predictor of well being for both groups., Conclusion: Research should focus on the special needs and circumstances of African-Americans, because protective factors may not have the same impact in different groups of the population.
- Published
- 1999
- Full Text
- View/download PDF
442. Caregiver behaviors and resources influence child height-for-age in rural Chad.
- Author
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Bégin F, Frongillo EA Jr, and Delisle H
- Subjects
- Agriculture, Chad, Child Nutritional Physiological Phenomena, Child, Preschool, Edible Grain, Humans, Infant, Mothers, Regression Analysis, Socioeconomic Factors, Surveys and Questionnaires, Aging, Behavior, Body Height, Caregivers, Nutritional Status, Rural Population
- Abstract
The purpose of this study was to identify caregiver characteristics that influence child nutritional status in rural Chad, when controlling for socioeconomic factors. Variables were classified according to the categories of a UNICEF model of care: caregiving behaviors, household food security, food and economic resources and resources for care and health resources. Sixty-four households with 98 children from ages 12 to 71 mo were part of this study. Caregivers were interviewed to collect information on number of pregnancies, child feeding and health practices, influence on decisions regarding child health and feeding, overall satisfaction with life, social support, workload, income, use of income, and household food expenditures and consumption. Household heads were questioned about household food production and other economic resources. Caregiver and household variables were classified as two sets of variables, and separate regression models were run for each of the two sets. Significant predictors of height-for-age were then combined in the same regression model. Caregiver influence on child-feeding decisions, level of satisfaction with life, willingness to seek advice during child illnesses, and the number of individuals available to assist with domestic tasks were the caregiver factors associated with children's height-for-age. Socioeconomic factors associated with children's height-for-age were the amount of harvested cereals, the sources of household income and the household being monogamous. When the caregiver and household socioeconomic factors were combined in the same model, they explained 54% of the variance in children's height-for-age, and their regression coefficients did not change or only slightly increased, except for caregiver's propensity to seek advice during child illnesses, which was no longer significant. These results indicate that caregiver characteristics influence children's nutritional status, even while controlling for the socioeconomic status of the household.
- Published
- 1999
- Full Text
- View/download PDF
443. Life-course events and experiences: association with fruit and vegetable consumption in 3 ethnic groups.
- Author
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Devine CM, Wolfe WS, Frongillo EA Jr, and Bisogni CA
- Subjects
- Adolescent, Adult, Female, Humans, Linear Models, Male, Middle Aged, Socioeconomic Factors, Telephone, Urban Population, Black or African American, Food Preferences ethnology, Fruit, Hispanic or Latino, Life Change Events, Vegetables, White People
- Abstract
Objective: To examine how life-course experiences and events are associated with current fruit and vegetable consumption in 3 ethnic groups., Design: A theoretic model developed from previous qualitative research guided the development of a telephone survey. Data were collected on fruit and vegetable consumption, sociodemographic characteristics, ethnic identity, and life-course events and experiences, including food upbringing, social roles, food skills, dietary changes for health, and practice of food traditions., Subjects/setting: Low- to moderate-income adults living in a northeastern US city were selected randomly from 3 ethnic groups: black (n = 201), Hispanic (n = 191), and white (n = 200)., Statistical Analyses: Bivariate and multiple linear regression analysis of associations between life-course variables and fruit and vegetable consumption., Results: Black, Hispanic, and white respondents differed significantly in life-course experiences, family roles, socio-demographic characteristics, and place of birth. Explanatory models for fruit and vegetable consumption differed among ethnic groups and between fruits and vegetables. Among black respondents, a college education was positively associated with fruit consumption; education and family roles contributed most to differences in fruit (R2 = .16) and vegetable (R2 = .09) consumption. Among Hispanic respondents, life-course experiences such as liking fruits and vegetables in youth, making dietary changes for health, and food skills were positively associated with fruit (R2 = .25) and vegetable (R2 = .35) consumption. Among white respondents, socio-demographic characteristics, such as being married with a young child or single with no child and having a garden as an adult, were positively associated with fruit (R2 = .20) and vegetable (R2 = .22) consumption., Applications/conclusions: An understanding of the determinants of food choice in different subcultural groups can be used to design effective nutrition interventions to increase fruit and vegetable consumption. Experiences such as eating fresh-picked fruits and vegetables while growing up or vegetable gardening as an adult may enhance fruit and vegetable consumption among members of some ethnic groups.
- Published
- 1999
- Full Text
- View/download PDF
444. Validation of measures of food insecurity and hunger.
- Author
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Frongillo EA Jr
- Subjects
- Female, Humans, Quality Control, Sensitivity and Specificity, Surveys and Questionnaires, United States, Food Supply, Hunger, Nutrition Surveys
- Abstract
The most recent survey effort to determine the extent of food insecurity and hunger in the United States, the Food Security Supplement, included a series of questions to assess this complex phenomenon. The primary measure developed from this Food Security Supplement was based on measurement concepts, methods and items from two previously developed measures. This paper presents the evidence available that questionnaire-based measures, in particular the national food security measure, provide valid measurement of food insecurity and hunger for population and individual uses. The paper discusses basic ideas about measurement and criteria for establishing validity of measures and then uses these criteria to structure an examination of the research results available to establish the validity of food security measures. The results show that the construction of the national food security measure is well grounded in our understanding of food insecurity and hunger, its performance is consistent with that understanding, it is precise within usual performance standards, dependable, accurate at both group and individual levels within reasonable performance standards, and its accuracy is attributable to the well-grounded understanding. These results provide strong evidence that the Food Security Supplement provides valid measurement of food insecurity and hunger for population and individual uses. Further validation research is required for subgroups of the population, not yet studied for validation purposes, to establish validity for monitoring population changes in prevalence and to develop and validate robust and contextually sensitive measures in a variety of countries that reflect how people experience and think about food insecurity and hunger.
- Published
- 1999
- Full Text
- View/download PDF
445. Symposium: Causes and Etiology of Stunting. Introduction.
- Author
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Frongillo EA Jr
- Subjects
- Child, Female, Gastrointestinal Diseases, Humans, Infant, Infections, Nutritional Physiological Phenomena, Pregnancy, Prenatal Exposure Delayed Effects, Growth Disorders etiology
- Published
- 1999
- Full Text
- View/download PDF
446. Hunger and food insecurity in the elderly: its nature and measurement.
- Author
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Wolfe WS, Olson CM, Kendall A, and Frongillo EA Jr
- Subjects
- Aged statistics & numerical data, Aged, 80 and over, Female, Humans, Male, New York epidemiology, Nutrition Surveys, Rural Health statistics & numerical data, Rural Population, Urban Health statistics & numerical data, Urban Population, Aged psychology, Hunger, Starvation epidemiology
- Abstract
To better understand the nature of food insecurity in the elderly and to improve its measurement, in-depth interviews were conducted with 41 urban Black and rural White elderly in 35 households, followed by telephone administration of commonly used measures of food insecurity in 24 of these elderly. Elderly food insecurity appears to follow a progression of severity, beginning with compromised diet quality, followed by food anxiety, socially unacceptable meals, use of emergency food strategies, and finally actual hunger. The five quantitative measures tested were compared to each elderly person's food insecurity status based on the in-depth interview. All measures had reasonable specificity, and good sensitivity for those experiencing severe food insecurity. However, the Cornell-Radimer, Community Childhood Hunger Identification Project (CCHIP) and Nutrition Screening Initiative (NSI) measures appeared more sensitive than the USDA food sufficiency or Urban Institute measures in correctly identifying those in the lesser stages of food insecurity.
- Published
- 1998
- Full Text
- View/download PDF
447. Infant feeding recommendations.
- Author
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Garza C and Frongillo EA Jr
- Subjects
- Age Factors, Humans, Infant, Infant Food standards, Bottle Feeding, Breast Feeding
- Published
- 1998
- Full Text
- View/download PDF
448. Food insufficiency exists in the United States: results from the third National Health and Nutrition Examination Survey (NHANES III).
- Author
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Alaimo K, Briefel RR, Frongillo EA Jr, and Olson CM
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Ethnicity, Family Characteristics, Humans, Income, Infant, Middle Aged, Socioeconomic Factors, United States epidemiology, Hunger, Nutrition Surveys
- Abstract
Objectives: The purpose of this study was to estimate the prevalence of food insufficiency in the United States and to examine sociodemographic characteristics related to food insufficiency., Methods: Data were analyzed from the third National Health and Nutrition Examination Survey, a cross-sectional representative sample of the civilian noninstitutionalized population living in households. Individuals were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not get enough food to eat., Results: From 1988 through 1994, the overall prevalence of food insufficiency was 4.1% and was primarily related to poverty status. In the low-income population, food insufficiency was positively associated with being Mexican American, being under the age of 60, having a family head who had not completed high school, participating in the Food Stamp Program, and not having health insurance. It was not related to family type or employment status of the family head. Over half of food-insufficient individuals lived in employed families., Conclusions: Food insufficiency is not limited to very low-income persons, specific racial/ethnic groups, family types, or the unemployed. Understanding food insufficiency is critical to formulating nutrition programs and policies.
- Published
- 1998
- Full Text
- View/download PDF
449. Socioeconomic and demographic factors are associated with worldwide patterns of stunting and wasting of children.
- Author
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Frongillo EA Jr, de Onis M, and Hanson KM
- Subjects
- Child Nutritional Physiological Phenomena, Child, Preschool, Educational Status, Female, Humans, Infant, Male, Nutrition Disorders epidemiology, Prevalence, Socioeconomic Factors, Wasting Syndrome economics, Wasting Syndrome etiology, Energy Intake, Global Health, Health Expenditures, Wasting Syndrome epidemiology
- Abstract
We estimated the variability among nations in the prevalence of stunting and wasting, evaluated which national factors are associated with stunting and wasting and examined the relationship of stunting with wasting. The World Health Organization Global Database on Child Growth, a comprehensive conceptual model and a database of national factors were used with variance components and regression analyses. There was substantial variability among nations and among provinces within nations. Most national variability for stunting (76%) and wasting (66%) was explained by national factors and geographic region. Higher energy availability, female literacy and gross product were the most important factors associated with lower prevalence of stunting. The association of health expenditures and stunting differed by region. Higher immunization rate and, for Asia only, energy availability were the most important factors associated with lower prevalence of wasting. Regional differences in the relationship between stunting and wasting were accounted for by national factors. Some factors associated with stunting and wasting differ at the national level. Child malnutrition within a household is greatly influenced by issues at national and provincial levels, and intervention should be considered at all three levels.
- Published
- 1997
- Full Text
- View/download PDF
450. Investigating the weanling's dilemma: lessons from Honduras.
- Author
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Frongillo EA Jr and Habicht JP
- Subjects
- Growth, Honduras, Humans, Infant, Longitudinal Studies, Randomized Controlled Trials as Topic, Research Design, Breast Feeding, Infant Food
- Abstract
When complementary foods should be introduced in the diets of infants in poor environments remains controversial. Resolution has been hampered by inadequate study designs. A study in Honduras has demonstrated an experimental design assessing multiple infant and maternal outcomes and provides information for planning sample size and accounting for dropouts in future studies. Further research to understand the cultural, social, and biologic aspects of complementary feeding is needed.
- Published
- 1997
- Full Text
- View/download PDF
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