Search

BACKGROUND & AIMS: Several studies have demonstrated that vegetarians and vegans have much lower plasma concentrations of omega-3 fatty acids (i.e., docosahexaenoic and eicosapentaenoic acids) when compared to those who eat fish. The purposes of this study were 1) to define the age and/or sex-specific docosahexaenoic plus eicosapentaenoic acids levels in red blood cell membranes (expressed as a percent of total fatty acids; hereafter the omega-3 index) in long-term vegans, and 2) to determine the effects of a vegetarian omega-3 supplement (254 mg docosahexaenoic plus eicosapentaenoic acids/day for 4 months) on the omega-3 index. METHODS: A sample (n = 165) of vegans was recruited, and their omega-3 index was determined using a dried blood spot methodology. A subset of 46 subjects with a baseline omega-3 index of

Objective: We examined the feasibility of Dance Dance Revolution (DDR), a dance video game, in participants' homes, to increase physical activity (PA) and to decrease sedentary screen time (SST). Methods And Procedures: Sixty children (7.5 ± 0.5 years) were randomized in a 2:1 ratio to DDR or to wait-list control (10-week delay). DDR use was logged, PA was measured objectively by accelerometry. SST was self-reported at weeks 0 and 10. At week 28, after both groups had access to DDR, accelerometry and SST were repeated. Results: Mean use of DDR was 89 ± 82 (range 0–660min) min per week (mpw). The DDR group showed increased vigorous PA and a reduction in light PA; the control group showed no increase in moderate and/or vigorous PA (MVPA) although they also had a reduction in light PA. Differences between the groups were not observed. The DDR group also reported a decrease in SST of −1.2 ± 3.7 h per week (hpw) (P < 0.05), whereas the controls reported an increase of +3.0 ± 7.7 hpw (nonsignificant). The difference in SST between the groups was significant, with less SST in the DDR group. Between weeks 10 and 28, numeric reductions in SST were reported in both groups. In the DDR group, SST at week 28 (8.8 ± 6.0 hpw) was lower than baseline (10.5 ± 5.5 hpw; P < 0.03). Discussion: This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA. Further study is needed to better characterize children and contexts in which DDR may promote a healthy lifestyle.

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignettebased moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Background There is little research on household and physical environment barriers to physical activity, particularly in minority populations at high risk for obesity and inactivity. Few studies include data on caregiver and daughter dyads. Formative data were used to develop intervention strategies and pathways for the Girls Rule! obesity prevention intervention, in under-studied high-risk pre-adolescents. Methods Participants included 12 African-American girls (mean age 7.8 years) and their 11 primary female caregivers (mean age 41.8 years)—eight mother–daughter dyads and three grandmother–granddaughter dyads—for a total of 51 interviews across 23 participants interviewed from April to October 2000.A qualitative approach was used for 51 semistructured in-depth interviews with 11 dyads (female caregiver and girl), consisting of up to three interviews per respondent (mean=2.4 interviews per respondent). Interviews were transcribed, coded, and systematically analyzed between January 2002 and January 2003 to identify recurrent patterns and themes related to physical activity. Results Findings indicate clear preference of the girls for sedentary, rather than active, behaviors. Caregivers were unaware of the amount of TV viewed and found positive benefits of TV viewing, including safe supervision of their daughters. Barriers to physical activity include perceived lack of affordable and accessible recreation facilities and low caregiver motivation. Potential intervention strategies identified by respondents include walking for exercise and transportation and several low-cost, favored physical activities, such as hopscotch, jumping rope, and dance. Conclusions These findings point toward several physical activity and obesity intervention strategies that can guide obesity prevention efforts.

Background. This study assessed the effects of the Health Works for Women (HWW) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina. Methods. Nine small to mid-size workplaces were randomly assigned to either intervention or delayed intervention conditions. After a baseline survey, an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months. Delayed worksites received one tailored magazine. Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6 and 18 months, respectively, and 538 women (63%) completed all three surveys. Results. At the 18-month follow-up, the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group (P < 0.05). Significant differences in fat intake were observed at 6 months (P < 0.05) but not at 18 months. The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group. The rates of smoking cessation and cancer screening did not differ between study groups. Conclusions. The HWW project was a successful model for achieving certain health behavior changes among blue-collar women.

INTRODUCTION Rural, minority populations are disproportionately affected by overweight and obesity and may benefit from lifestyle modification programs that are tailored to meet their unique needs. Obesity interventions commonly use goal setting as a behavior change strategy; however, few have investigated the specific contribution of goal setting to behavior change and/or identified the mechanisms by which goal setting may have an impact on behavior change. Furthermore, studies have not examined goal setting processes among racial/ethnic minorities. Using data from an obesity intervention for predominately minority women in rural North Carolina, this study sought to examine whether intervention participation resulted in working on goals and using goal setting strategies which in turn affected health behavior outcomes. It also examined racial/ethnic group differences in working on goals and use of goal setting strategies. METHODS Data came from a community-based participatory research project to address obesity among low-income, predominately minority women in rural North Carolina. A quasi-experimental intervention design was used. Participants included 485 women aged 18 years and over. Intervention participants (n=208) received health information and goal setting support through group meetings and tailored newsletters. Comparison participants (n = 277) received newsletters on topics unrelated to obesity. Surveys assessed physical activity, fruit and vegetable intake, goal-related stage of change, and use of goal setting strategies. Chi squared statistics were used to assess intervention group differences in changes in goal-related stage of change and use of goal setting strategies as well as racial/ethnic group differences in stage of change and use of goal setting strategies at baseline. The causal steps approach of Baron and Kenny was used to assess mediation. RESULTS Intervention compared to comparison participants were more likely to move from contemplation to action/maintenance for the goals of improving diet (58% intervention, 44% comparison, p= 0.04) and physical activity (56% intervention, 31% comparison, p ≤ 0.0001). Intervention group differences were not found for moving from precontemplation to a higher category. At baseline, black compared to white participants were more likely to be working on the goals of getting a better education (p < 0.0001), owning a home (p < 0.01), starting a business (p < 0.0001), and improving job skills (p

Purpose. This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study. Design. Cross-sectional. Setting. Rural manufacturing worksites in North Carolina. Subjects. Participants were 859 women aged 18 and over. Measures. The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance. Results. Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise. Conclusions. The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.

The incidence of neural tube defects including myelomeningocele, which is one of the most common causes of infant and childhood disability, can be substantially reduced by folic acid supplementation to the diet of women before and during the early stages of pregnancy. All females of childbearing age should be taking folic acid supplements of 0.4 mg/day (400 μg/day) and consuming a diet rich in folate. Because many pregnancies are unplanned, supplementation should not await plans for pregnancy. Because pediatric nurse practitioners are in frequent contact with both adolescent patients and patients whose mothers are of childbearing age, and because pediatric nurse practitioners have an interest in preventing neural tube defects in future pediatric patients, they are in a good position to provide the necessary anticipatory guidance regarding the critical need for adequate folic acid intake by females of childbearing age. This article discusses and includes guidelines for providing this anticipatory guidance.

Social support has been found to predict success with health behavior change but, as yet, few studies examine the relationship between social support and dietary change in a low-income population. We developed a social support for dietary change measure for a low-income, hypercholesterolemic population and tested its predictive utility in a clinical trial with a dietary intervention. Questions were administered by telephone to 443 patients enrolled in the trial. Dietary change was measured by the Dietary Risk Assessment Factor analysis revealed three social support factors: friend, family and negative support, and a fourth factor, motivation to change. Multiple regression analysis revealed that motivation to change was predictive of change to a less atherogenic diet Results of a gender-stratified analysis revealed that friend support was a significant predictor of dietary change for women but not for men. Interaction

Objectives: HOPE Works was an innovative, community-based participatory research (CBPR) intervention aimed at addressing health promotion and obesity in the context of social determinants for obese, low-income and minority rural North Carolina women. This study incorporated multiple social health determinants, including hope, which assesses participants’ abilities to set and achieve goals to reach desired health and life changes. Methods: Community Coordinators identified women to serve as HOPE Circle Leaders who received training and recruited women from their social networks. Thirty-four Circles met bi-weekly for 6 months following a manual-based curriculum and received tailored newsletters addressing health and economic literacy. Comparison women were drawn from the same communities. The primary outcome was weight loss. Secondary outcomes were moderate and vigorous physical activity (MVPA), fruit and vegetable (FV 277 comparison). Non-completers (117 intervention; 119 comparison) differed by race, employment status, household income, and contribution to household income in the past two years (all p < 0.05). Intervention women lost 4.5 (±1.2) pounds compared to 0.4 (±0.4) pounds for comparison women (p = 0.054 cohort, p = 0.154 ITT); 22.5% and 13.1% of the intervention and comparison groups respectively lost ≥5% of their body weight. Mean (SE) difference in total MVPA between groups was +51.8 (±19.2) minutes/week (p = 0.007), with non-significant improvement in FV however, intervention women marginally improved on Agency (goal directed energy) (p = 0.060). Conclusion: Women receiving a community-based weight management program based on addressing social determinants can successfully lose weight. Future, streamlined efforts addressing the needs of women including those unable to participate are important to enhance program reach and public health impact.

According to hope theory, hope is defined as goal-directed thinking in which people perceive that they can find routes to desired goals and the motivation to use those routes. The purpose of this study was to explore relationships between hope and body mass index and hope and self-rated health among women completing a community survey conducted in four rural counties in eastern North Carolina. The survey was administered as part of Hope Works, a participatory, community-led intervention program to improve weight, health and hope among low-income women in rural North Carolina. Survey data from 434 women were analyzed. In multivariate models adjusting for age, race, education and income, higher hope was positively related to self-reported health (OR:0.92; 95% CI: 0.89–0.95) and negatively related to BMI (P

Purpose Parental and intervention-specific environmental supports were examined as potential reinforcers for physical activity and use of a video game, Dance Dance Revolution (DDR), among a cohort of 7- to 8-year-old children. Methods Sixty children were randomized to an intervention (n = 40) or a control (n = 20) group. Physical activity was measured with accelerometry and DDR logs. Parental support for their child's physical activity was assessed via a questionnaire. DDR-specific environmental supports were captured on an environmental home screen and the DDR log. Results At baseline, the absence of other video games and parent DDR participation was associated with child participation in DDR. At follow-up, DDR participation of siblings and friends was associated with child participation in DDR. Conclusion The primary findings of this study suggest that parental and peer participation in DDR may play a role in children's initial and sustained participation in DDR.

To qualitatively and quantitatively examine body image ideals and perceived weight-related health among African-American girls and their female caregivers to inform intervention development for Girls Rule!, an obesity prevention pilot program.Formative study using qualitative data from semi-structured interviews and validated quantitative body image silhouette assessment among girls (N=47) and caregivers (N=44). The participants were a convenience sample of African-American church members from North Carolina. Differences were evaluated between perceived: 1) current and ideal body size; 2) current and unhealthy body size; and 3) ideal and unhealthy body size.Thirty-seven percent of the girls and 77% of the caregivers were overweight or obese. Three body image themes emerged from the qualitative interviews: 1) being fat is unhealthy; 2) caregivers are role models (positive and negative) for body image ideals; and 3) smaller body size is important for wearing fashionable clothing. A series of 9 body silhouettes were used to assess perceptions of both girls and caregivers. Overall, both girls (2.9 +/- 1.4) and caregivers (4.4 +/- 1.4) ideal body size was significantly (P.01) smaller than their current body size (3.7 +/- 1.3 girls; 6.3 +/- 2.2 caregivers). Both girls (3.7 +/- 1.4) and caregivers (6.7 +/- 2.0) indicated that their current body sizes were statistically significantly (P.05) smaller that what they considered to be unhealthy (7.9 +/- 1.4 girls; 7.9 +/- 1.2 caregivers).Results suggest that most of these African-American participants were not satisfied with their current body size and desired a smaller body. At the same time, both girls and caregivers failed to recognize the potential health consequences associated with their current body size. Critical issues for designing obesity prevention programs include positive role modeling within the family and addressing the association of body size with health risk.

There is little research on household and physical environment barriers to physical activity, particularly in minority populations at high risk for obesity and inactivity. Few studies include data on caregiver and daughter dyads. Formative data were used to develop intervention strategies and pathways for the Girls Rule! obesity prevention intervention, in under-studied high-risk pre-adolescents.Participants included 12 African-American girls (mean age 7.8 years) and their 11 primary female caregivers (mean age 41.8 years)--eight mother-daughter dyads and three grandmother-granddaughter dyads--for a total of 51 interviews across 23 participants interviewed from April to October 2000.A qualitative approach was used for 51 semistructured in-depth interviews with 11 dyads (female caregiver and girl), consisting of up to three interviews per respondent (mean=2.4 interviews per respondent). Interviews were transcribed, coded, and systematically analyzed between January 2002 and January 2003 to identify recurrent patterns and themes related to physical activity.Findings indicate clear preference of the girls for sedentary, rather than active, behaviors. Caregivers were unaware of the amount of TV viewed and found positive benefits of TV viewing, including safe supervision of their daughters. Barriers to physical activity include perceived lack of affordable and accessible recreation facilities and low caregiver motivation. Potential intervention strategies identified by respondents include walking for exercise and transportation and several low-cost, favored physical activities, such as hopscotch, jumping rope, and dance.These findings point toward several physical activity and obesity intervention strategies that can guide obesity prevention efforts.

In the aftermath of Hurricane Floyd in 1999, a Community Advisory Committee requested assistance from its university partners (University of North Carolina) to address stress and increased risk for intimate partner violence (IPV). Collected from 12 study work sites, baseline data indicated that IPV rates were higher among blue-collar women in eastern North Carolina than national population-based rates suggest. IPV victims reported higher levels of perceived stress, psychological distress, somatic complaints, and post-traumatic stress disorder (PTSD) symptoms than did nonvictimized coworkers. As for the relationship of the flood to IPV, no significant increase in IPV incidence occurred after the flood. Regardless of their flood experience, however, IPV victims consistently reported greater stress, PTSD symptoms, and somatic and psychological problems. Moreover, IPV victims may be at higher risk for stress-mediated chronic illnesses and for using negative coping behaviors. This study uses an established trusting relationship between researchers and community members to explore community needs and inform intervention design.

Cardiovascular disease (CVD) is a major public health concern in the United States. We developed an annual training course, Nutrition and Public Health, A Course for Community Practitioners (NPH), to address the identified training needs of state staff responsible for designing and implementing the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program and to support other health professionals working in programs that address chronic disease prevention and management.After conducting a needs assessment with state-level WISEWOMAN staff in 2001 to identify topics of interest, we formed an advisory committee to provide guidance on topics, theoretical frameworks, training concerns, and multilevel intervention approaches. The first week-long training course, which included an intensive field practicum, was implemented in the fall of 2002.Participants rated three fourths of the elements listed in a posttraining evaluation as a course strength, giving particularly high ratings to various indicators of course quality (100%) and networking opportunities (95%). Just over half (55%) rated the field practicum as a course strength. Four fifths (83%) of participants responded to a 6-month follow-up evaluation, and most indicated that the course had increased their knowledge and skills and increased their confidence in planning programs.Unique features of the course include its suitability for public health practitioners not previously trained in nutrition, its promotion of multilevel interventions, and its focus on CVD risk reduction and nutrition interventions for underinsured and uninsured populations.

It seems that many people, including dietetics professionals and other nutrition experts, are unclear about some of the fundamental yet complex concepts behind the influence of dietary macronutrients (ie, protein, carbohydrate, and fat) on appetite regulation. Recent research has begun to unravel some of the more complicated physiological processes of appetite control and regulation generated by hormones such as leptin, ghrelin, and the gut hormone peptide YY3-35. Although the processes by which the macronutrients in our foods influence appetite regulation have been a topic of study for decades, they remain confusing and are often misunderstood. The objective of this article is to define the terminology commonly used to discuss the macronutrients' roles in appetite regulation and to discuss the interrelated concepts and roles of taste, palatability, and energy density.

There is an increasing emphasis on designing health promotion interventions for low-socioeconomic-status (SES) individuals. However, many previously developed behavior change tools have not been tested in this population. Self-efficacy was measured at pre- and postintervention as part of a randomized clinical trial to reduce cholesterol levels in rural low-SES Southern adults. A 22-item scale was designed and validated to measure subjects' confidence in their abilities to make dietary changes. High mean self-efficacy was noted in both control and intervention subjects at pre- and postintervention. Mean self-efficacy score was a significant predictor of dietary change at both preintervention and postintervention. This study demonstrates that self-efficacy is a predictor of ability to make dietary changes in a low-SES rural population. This finding is of significance to researchers and practitioners wishing to design theory-based health promotion interventions in this population.