Adapting the Community Readiness Model and Validating a Community Readiness Tool for Childhood Obesity Prevention Programs in Iran / 예방의학회지

Objectives@#It is critical to assess community readiness (CR) when implementing childhood obesity prevention programs to ensure their eventual success and sustainability. Multiple tools have been developed based on various conceptions of readiness. One of the most widely used and flexible tools is based on the community readiness model (CRM). This study aimed to adapt the CRM and assess the validity of a community readiness tool (CRT) for childhood obesity prevention programs in Iran. @*Methods@#A Delphi study that included 26 individuals with expertise in 8 different subject areas was conducted to adapt the CRM into a theoretical framework for developing a CRT. After linguistic validation was conducted for a 35-question CR interview guide, the modified interview guide was evaluated for its content and face validity. The quantitative and qualitative analyses were performed using Stata version 13 and MAXQDA 2010, respectively. @*Results@#The Delphi panelists confirmed the necessity/appropriateness and adequacy of all 6 CRM dimensions. The Persian version of the interview guide was then modified based on the qualitative results of the Delphi study, and 2 more questions were added to the community climate dimension of the original CRT. All questions in the modified version had acceptable content and face validity. The final CR interview guide included 37 questions across 6 CRM dimensions. @*Conclusions@#By adapting the CRM and confirming linguistic, content, and face validity, the present study devised a CRT for childhood obesity prevention programs that can be used in relevant studies in Iran.

Content analysis of food advertising in Iranian children's television programs

Advertisements can influence children's health related behaviors. Television advertisements are the main avenues directing commercials at children in Iran. This study aimed to explore the content of food advertisement during children's television programs in 2007-8 and to compare it with those reported in 2000. All advertisements broadcasted before, during, and after children's programs aired on two major Iran national television networks were videotaped for a period of 4 weeks during 2007- 8. For each advertisement, type of product[s] and mode of presentation[s] were coded. A total of 229 television advertisements were broadcasted. Food commercials were the most frequent group [31%] across the two channels. Among the food products advertised, calorie dense foods, including chocolate, soft drinks, extruded cereals, ice cream, cookies and candies were the most frequent. The appeal mainly used in television food advertisements was "stimulation of hunger/thirst" [38.5%]. The advertisements were mostly presented as animations [54%] and the messages used were mainly directed to good taste. Although the total number of food advertisements during children's television programs has decreased but the consumption of high fat, high sugar, low nutrient dense foods continues to be promoted. Policies to address the issue should be scrutinized

Development and Validation of a Food Frequency Questionnaire for Assessing Dietary Calcium in Children

This study aimed to develop and validate a food frequency questionnaire [FFQ] for measuring calcium intake in 9-13 years old children in Tehran, Iran. A 56-item FFQ containing main contributors of calcium in Iranian diet was designed. Criterion validity of the calcium specific FFQ was evaluated through comparing its result with five 24-h recalls as the reference method. Reproducibility was measured by twice administration of FFQ, one month apart. The study was performed in the selected primary and middle schools of Tehran city. Subjects included 184 children aged 9-13 years [90 girls and 94 boys], who were recruited through two-stage systematic cluster sampling from 20 primary and middle schools. Mean calcium intake was 922.8 +/- 322.3 and 876.0 +/- 491.8 mg/d for the 24-h recalls and FFQ, respectively, indicating a mean difference of 46.7 +/- 458.7 mg/d [P<0.001]. Corrected Pearson's correlation was 0.57. Cross-classification analysis of the FFQ and 24-h recalls classified 80% of the subjects in the same or adjacent category, and 6% in the extreme quartiles. The FFQ correctly identified 85% of the children consuming less calcium than the age-specific Recommended Dietary Allowance [RDA] [1300 mg/d]. Pearson's correlation for repeated administrations was 0.65. Cross-classification analysis of the repeated administration of FFQ classified 81% of the subjects in the same or adjacent quartiles, and 3.3% in the extreme categories. The FFQ underestimates mean calcium intake of a group, and has limited use to estimate calcium intake for individuals. However, it has acceptable validity and reproducibility for epidemiologic studies to assess a group's mean calcium intake

Effectiveness of community-based intervention to promote Iran's food-based dietary guidelines

Dietary Guidelines are considered as a useful tool for the promotion of healthy dietary behaviors. In Iran, despite the development of the latest National Food-Based Dietary Guidelines, in 2006, it has not been introduced at the community level yet. The present study aims to evaluate the effectiveness of an intervention program to promote Iran's Food-Based Dietary Guidelines [IFBDGs] in urban adult women. A sample of 435 healthy women, aged 26 to 54 years, was randomly assigned to the intervention or control groups. The intervention group was designed based on the Health Belief Model [HBM]. Each subject in the intervention group received three sessions of group education on IFBDGs and the food guide pyramid and participated in a healthy cooking class. Dietary intake, cognitive outcomes related to the constructs of the HBM, physical activity, and the BMI were measured in both groups before, immediately, and one month after the intervention. The outcome measures were compared with the analysis of covariance [ANCOVA], by adjusting for baseline values. The intervention group had a significantly lower total daily energy intake than the control group after the intervention [P=.000]. The adjusted differences in the changes of body mass index from the baseline were significant in both post intervention measurements in the intervention group compared to the controls. The intervention designed based on the Health Belief Model was effective in improving the adherence to FBDGs and could serve as a basic model for the promotion of healthy nutrition behavior among women in the primary health care setting

Effect of a school-based intervention based on social cognitive theory on fruit and vegetable consumption in middle school students in Tehran

Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives; and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable [F and V] intake of female adolescents in Tehran. This experimental school based field trial was conducted on 296 female students aged 10-13 years old [157 in the intervention and 139 in the control groups]. The intervention included classroom nutrition education on F and V and increasing availability of Fand V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F and V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis. After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group. Through the intervention process, many valuable experiences were gained to be used in future interventions

Prevalence of overweight and obesity among junior high school students in a district of Tehran

To determine the prevalence of overweight and obesity among a sample of middle class junior high school students in a district of Tehran and its association with certain demographic and dietary factors this study was carried out. Weight, height, waist and hip circumferences were measured and information on two-day food intake and demographics on 398 students aged 10-15 years from district 6 in Tehran were collected. Prevalence of overweight and obesity in the studied girls were 19%, 6.5% and in boys were 14%, 13%, respectively. There was an inverse relationship between numbers of siblings and BMI. Overweight/obese students, bought snacks from school shops more frequently than other students did. Findings showed that the high prevalence of overweight/obesity can be related to the household size, including the number of siblings and the pattern of snack purchase by the students