Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned.

OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2-6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.

Implementation of B'More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention.

B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.

Partnering with carryouts: implementation of a food environment intervention targeting youth obesity.

Youth obesity is a major public health problem in the United States, especially among urban-based, minority youth. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment, including carryouts, to increase access to and demand for healthy, affordable foods. The objective of this article is to describe the development and implementation of BHCK's carryout intervention. Process evaluation was conducted to assess intervention reach (number of interactions with youth and adults either in person or on social media), dose delivered (number of food samples and promotional materials distributed, social media posts and meetings with owners) and fidelity (availability of promoted items). Overall, the carryout intervention showed moderate to optimal reach, moderate to optimal dose delivered and moderate to optimal fidelity. These findings demonstrate a successfully implemented carryout intervention in a low-income urban setting. Lessons learned about new methods for engaging the community and increasing demand for healthy food can be used to inform future studies and programs to improve the food environment.

Using the theory of normative social behavior to understand compliance with a smoke-free law in a middle-income country.

Smoke-free laws, which ban smoking in public venues, can be effective in protecting public health, but it has been difficult to achieve compliance with these laws in low- and middle-income countries. This study was conducted to understand the social norms around public smoking and learn how to improve compliance in Bogor, the first Indonesian city to pass a comprehensive smoke-free law. Eleven stratified focus groups were conducted (n = 89). Data were analyzed using the theory of normative social behavior, which posits that the influence of descriptive norms (perceptions about what other people do) on behavior is moderated by injunctive norms (perceptions about what one is expected to do), outcome expectations and group identity. The findings showed that participants perceived smoking in public to be common for men (descriptive norm). Public smoking is acceptable except in places with air conditioning and around children or pregnant women (injunctive norms). Men smoke without penalty of social or legal sanctions (outcome expectations) and may feel affiliation with other smokers (group identity). Together, these factors support public smoking and inhibit compliance with the smoke-free law. Theory-based communication and policy remedies are suggested that may bolster compliance with Bogor's smoke-free law given the current pro-smoking norms.

Low-income African-American adults share weight status, food-related psychosocial factors and behaviours with their children.

OBJECTIVE: This study aims to examine the extent to which low-income African-American children's weight status, psychosocial characteristics and food-related behaviours are associated with that of their adult caregivers. METHODS: Cross-sectional data from baseline evaluation of B'More Healthy Communities for Kids obesity prevention trial were used. Outcomes of interest were children's overweight and/or obesity status, food-related self-efficacy, knowledge, intentions and healthier/less healthy food acquisition scores. The primary exposures were adult caregiver's overweight and/or obesity status, their psychosocial factors and food acquisition scores. Multiple logistic regression analyses were used to assess associations. RESULTS: Children had higher odds of overweight or obesity if they had an overweight/obese caregiver (odds ratio [OR] 4.04, 95% confidence interval [95%CI] 1.59-10.28) or an obese caregiver (OR 2.50, 95%CI 1.39-4.51). Having a caregiver in the highest quartile of self-efficacy, food intentions and healthy food acquisition patterns was associated with higher odds of their child also having a higher score on these factors (self-efficacy: OR 3.77 [95%CI 1.76-8.04]; food intentions: OR 1.13 [95%CI 1.01-1.27]; and healthy food acquisition: OR 2.19 [95%CI 1.05-4.54]). CONCLUSIONS: Child and adult caregiver weight status and psychosocial characteristics were positively associated in this low-income, urban population. These findings may help inform obesity treatment or prevention programmes and interventions aimed at parents and families.

Perceptions of physical activity, activity preferences and health among a group of adult women in urban Ghana: a pilot study.

BACKGROUND: Obesity and other lifestyle-related chronic diseases impact urban West African women at high rates. Physical activity (PA) can improve these health outcomes but there is little published data on the associated psychosocial predictors in this population. OBJECTIVES: We aimed to explore preliminary associations between perceptions of PA, PA behaviours, and health in a group of Ghanaian women. METHODS: Non-experimental, cross-sectional case study using a mixed-methods approach. Focus groups and in-depth interviews with a convenience sample of Ghanaian women, fitness trainers and clergy comprised the qualitative phase. A self-administered survey (n=218) comprised the quantitative phase. Constant comparative method, logistic regression, component and factor analyses were used for analysis. RESULTS: Women viewed activities of daily living like housework as PA; rarely utilized organized fitness facilities; understood "rigorous" PA as professional male athleticism; and took interest in socialized PA. Mean age was 49.4 years. Mean body mass index was 30.3 kg/m2. The majority (75.9 %) reported exercising sometimes or often. Half (48.4%) reported a lifestyle-related chronic disease. "Weight loss," "health concerns" and "increased energy," were top motivators for PA. "Can't find the time," "work/family obligations," and "don't have a facility" were top barriers. Presence of hypertension, hypercholesterolemia and prior weight loss correlated with the slimming motivator (adjusted odds ratio 2.59, p=0.008; AOR 3.56, p=0.012; AOR 3.36, p=<0.001). CONCLUSION: Among those surveyed, PA motivators and barriers were associated with demographics, PA exposure, and health status. Further research on unique PA perceptions, behaviours and health could catalyze health promotion through culturally relevant fitness programming.

Healthy Foods North improves diet among Inuit and Inuvialuit women of childbearing age in Arctic Canada.

BACKGROUND: Healthy Foods North (HFN) is a community-based intervention designed to promote a healthy diet and lifestyle of Inuit and Inuvialuit populations in Arctic Canada. The objective of the present study was to determine the effects of HFN on the nutrient intake of women of childbearing age. METHODS: Six communities in Nunavut (n = 3) and the Northwest Territories (n = 3) were selected for programme implementation; four received a 12-month intervention and two served as controls. Quantitative food frequency questionnaires were used to assess dietary intake at baseline and 1 year post-intervention. Among women participants aged 19-44 years (n = 136), 79 were exposed to the intervention and 57 were not. Mean daily energy and nutrient intake and density were determined. Dietary adequacy was assessed by comparing the women's daily nutrient intakes with dietary reference intakes (DRI). RESULTS: Main outcomes were the pre- to post-intervention changes between intervention and control groups for energy and selected nutrient intakes, nutrient density and dietary adequacy. Among the participants, the intervention had a beneficial effect on vitamin A and D intake. The percentage of individuals with nutrient intakes below the DRI increased from pre- to post-intervention for vitamin A and D in the control group but only for vitamin A in the intervention group. The programme did not have a significant impact on calorie, sugar, or fat consumption. CONCLUSIONS: The HFN programme is effective in mitigating some of the negative impacts of the nutrition transition on dietary adequacy among Inuit and Inuvialuit women of childbearing age.

Utility of non-high-density lipoprotein cholesterol in assessing incident type 2 diabetes risk.

AIMS: Traditional lipid indices have been associated with type 2 diabetes, but limited data are available regarding non-high-density lipoprotein (non-HDL) cholesterol. In view of recent guidelines for the clinical management of dyslipidemia recommending the monitoring of non-HDL cholesterol as a secondary target after achieving the low-density lipoprotein (LDL) cholesterol goal, we aimed to assess the association of non-HDL cholesterol with incident type 2 diabetes and compare its utility as a risk predictor with traditional lipid variables in Aboriginal Canadians. METHODS: Of 606 diabetes-free participants at baseline, 540 (89.1%) returned for 10-year follow-up assessments. Baseline anthropometry, blood pressure, fasting insulin and serum lipids were measured. Fasting and 2-h postload glucose were obtained at baseline and follow-up to determine the incidence of type 2 diabetes. RESULTS: The cumulative incidence of type 2 diabetes was 17.5%. Higher non-HDL cholesterol, total-to-HDL cholesterol ratio, apolipoprotein B, triglyceride and LDL cholesterol and lower HDL cholesterol concentrations were individually associated with incident type 2 diabetes in univariate analyses (all p < 0.05). Non-HDL cholesterol was a superior determinant of incident diabetes compared with LDL cholesterol (comparing C-statistics of univariate models p = 0.01) or HDL cholesterol (p = 0.004). With multivariate adjustment including waist circumference, non-HDL cholesterol remained associated with incident diabetes [odds ratio (OR) 1.42 (95% confidence interval, CI 1.07-1.88)], while LDL cholesterol and HDL cholesterol became non-significant. CONCLUSIONS: Non-HDL cholesterol was associated with incident type 2 diabetes and was superior to LDL cholesterol as a risk predictor in this population. Further studies are required to establish the utility of non-HDL cholesterol in non-Aboriginal populations.

Impact of the changing food environment on dietary practices of an Inuit population in Arctic Canada.

BACKGROUND: Nutritional inadequacies and increasing chronic disease prevalence amongst Inuit in the Canadian Arctic highlight the need to address dietary practices. Research is needed to investigate the individual and environmental factors impacting diet to guide interventions. The present study aimed to explore multiple community perspectives of key factors affecting food choice and availability in Inuit communities in Nunavut, Canada. METHODS: Semi-structured in-depth interviews were conducted with Inuit adults (n=43) in two communities in Nunavut, Canada, and included community members, community leaders, elders, health staff and food shop staff. The interviewer transcribed the audio-taped interviews. Data were analysed using codes and the constant comparative method to determine categories and emergent themes. RESULTS: Thirty-three Inuit (27 females and six males) and 10 non-Inuit (four females and six males) adults participated. Traditional foods procured through hunting and gathering were considered the healthiest by community members, although multiple factors inhibited their procurement, including high petrol cost and decrease in traditional knowledge about hunting and gathering practices. Cost and quality were the main barriers to purchasing healthy foods at the shops. Community leaders and health staff identified multiple barriers to healthy eating in the community, such as skills to prepare some shop-bought foods. Shop managers identified several challenges to providing fresh produce and other perishable foods, such as long transportation routes that increase costs and harsh climatic conditions that may cause spoilage. They also cited factors influencing their decisions regarding whether to stock/discontinue certain foods, such as customers' requests, food cost and shelf-life. CONCLUSIONS: An intervention to reduce chronic disease risk and improve dietary adequacy amongst Nunavut Inuit may be effective by supporting individual behaviour modifications with food environment changes.

Important psychosocial factors to target in nutrition interventions to improve diet in Inuvialuit communities in the Canadian Arctic.

BACKGROUND: With increasing chronic disease amongst Inuvialuit in the Canadian Arctic, research on dietary behaviours and their determinants in this population is needed to develop nutritional behaviour change intervention strategies. The present study aimed to assess the knowledge, self-efficacy and intentions towards healthy eating and healthy eating behaviours of Inuvialuit adults in the Northwest Territories (NWT), Canada. METHODS: The Adult Impact Questionnaire was developed from behavioural theories and workshops held in the communities. It was conducted with adult Inuvialuit (≥19 years) from randomly selected households in three NWT communities to collect data on the psychosocial constructs of healthy food knowledge, self-efficacy and intentions, and the dietary behaviours of healthy and unhealthy food acquisition and preparation. Associations between demographic, socioeconomic, psychosocial constructs and behaviours were analysed using multivariate linear regression. RESULTS: The 228 participants [mean (SD) age 43.4 (13.6) years; response rates 65-85%] acquired non-nutrient-dense foods a mean (SD) of 2.7 (3.0) times more frequently than nutrient-dense, low sugar and low fat foods. Increased intention was associated with a greater frequency of acquiring healthy foods (ß=0.17, P=0.012) and a lower frequency of acquiring unhealthy foods (ß=-0.18, P=0.008). Overall, participants reported using food preparation methods that reduce fat content slightly more than methods that add fat [mean (SD) score 0.3 (1.9)]. Use of healthier food preparation methods was associated with higher levels of healthy food knowledge (ß=0.26, P<0.001), self-efficacy (ß=0.29, P<0.001) and intentions (ß=0.22, P=0.001). CONCLUSIONS: Healthy food intention was the construct most significantly associated with all three healthier dietary behaviours. Interventions that target intentions to change food choice and preparation may be effective strategies to improve dietary intake in Inuvialuit populations.

Healthy food intentions and higher socioeconomic status are associated with healthier food choices in an Inuit population.

BACKGROUND: Changing food behaviours amongst Canadian Inuit may contribute to rising chronic disease prevalence, and research is needed to develop nutritional behaviour change programmes. The present study examined patterns of food acquisition and preparation behaviours amongst Inuit adults in Nunavut and associations with psychosocial and socioeconomic factors. METHODS: Developed from behavioural theories and community workshops, Adult Impact Questionnaires were conducted with adult Inuit (≥19 years) from randomly selected households in three remote communities in Nunavut, Canada, to determine patterns of healthy food knowledge, self-efficacy and intentions, frequencies of healthy and unhealthy food acquisition and healthiness of preparation methods. Associations between these constructs with demographic and socioeconomic factors were analysed using multivariate linear regressions. RESULTS: Amongst 266 participants [mean (SD) age 41.2 (13.6) years; response rates 69-93%], non-nutrient-dense foods were acquired a mean (SD) of 2.9 (2.3) times more frequently than nutrient-dense, and/or low sugar/fat foods. Participants tended to use preparation methods that add fat. Intentions to perform healthy dietary behaviours was inversely correlated with unhealthy food acquisition (ß=-0.25, P<0.001), and positively associated with healthy food acquisition (ß=0.22, P<0.001) and healthiness of preparation methods (ß=0.15, P=0.012). Greater healthy food knowledge and self-efficacy were associated with intentions (ß=0.21, P=0.003 and ß=0.55, P<0.001, respectively). Self-efficacy was associated with healthier preparation (ß=0.14, P=0.025) and less unhealthy food acquisition (ß=-0.27, P<0.001), whilst knowledge was associated with acquiring healthy foods (ß=0.13, P=0.035). Socioeconomic status was positively associated with healthy preparation and food acquisition behaviours. CONCLUSIONS: Interventions to improve diet in Nunavut Inuit should target healthy food intentions, knowledge and self-efficacy. Behaviour change strategies emphasising economic benefits of a healthy diet should be employed to target individuals of low socioeconomic status.

Awareness of chronic disease diagnosis amongst family members is associated with healthy dietary knowledge but not behaviour amongst Inuit in Arctic Canada.

BACKGROUND: The extent to which awareness of chronic disease (CD) diagnosis affects one's healthy food knowledge, self-efficacy and intentions or healthy dietary and physical activity (PA) behaviours remains unexplored among Inuit in Canada. METHODS: A food frequency questionnaire and an adult impact questionnaire were used in a cross-sectional study to collect self-reported data on daily energy and nutrient intake, PA and the diagnosis of hypertension, diabetes, heart disease and cancer amongst adult Inuit and their family members. Associations between awareness of personal and family CD status and healthy food knowledge, self-efficacy and intentions, percentage of energy consumed from non-nutrient-dense foods and PA were assessed via ordinal logistic regression. RESULTS: Of the 266 participants, those who self-reported CD for both themselves and their relative(s) were more likely to have high healthy food knowledge [odds ratio (OR)=2.45] than those who did not. Reporting hypertension and heart disease amongst only relatives increased the likelihood of high knowledge (OR=5.20) and intentions (OR=5.10) for healthy eating. Heart disease in both participants and their relatives was associated with high levels of PA (OR=12.24). However, there were no associations when only participants (but not their relatives) reported having CD. A joint effect between a high level of education and awareness of CD was positively related to high food knowledge (OR=38.93). An inverse association between awareness of CD and unhealthy eating was not observed. CONCLUSIONS: Awareness of a relative having a CD was a more important factor in increasing knowledge and, to a lesser degree, self-efficacy or intentions to eat healthy than participants' awareness of personal CD. However, awareness was not associated with lower non-nutrient-dense food intake.

Addressing the public health burden caused by the nutrition transition through the Healthy Foods North nutrition and lifestyle intervention programme.

Dietary inadequacies, low levels of physical activity, excessive energy intake and high obesity prevalence have placed Inuit and Inuvialuit populations of the Canadian Arctic at increased risk of chronic disease. An evidence-based, community participatory process was used to develop Healthy Foods North (HFN), a culturally appropriate nutrition and physical activity intervention programme that aimed to reduce risk of chronic disease and improve dietary adequacy amongst Inuit/Inuvialuit in Nunavut and the Northwest Territories. HFN was implemented over the course of 12 months in a series of seven phases between October 2008 and 2009 (Nunavut) and June 2008 and 2009 (Northwest Territories). Combining behaviour change and environmental strategies to increase both the availability of healthful food choices in local shops and opportunities for increasing physical activity, HFN promoted the consumption of traditional foods and nutrient-dense and/or low energy shop-bought foods, utilisation of preparation methods that do not add fat content, decreased consumption of high-energy shop-bought foods, and increased physical activity. Messages identified in the community workshops, such as the importance of family eating and sharing, were emphasised throughout the intervention. Intervention components were conducted by community staff and included working with shops to increase the stocking of healthy foods, point of purchase signage and promotion in shops and community settings, pedometer challenges in the workplace and use of community media (e.g. radio and cable television advertisements) to reinforce key messages. HFN represents an innovative multilevel approach to the reduction of chronic disease risk factors amongst Inuit and Inuvialuit, based on strong collaboration with local agencies, government and institutions.

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations.

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.

Development of an integrated diabetes prevention program with First Nations in Canada.

Type 2 diabetes mellitus is a major cause of morbidity and mortality among First Nations in Canada. We used multiple research methods to develop an integrated multi-institutional diabetes prevention program based on the successful Sandy Lake Health and Diabetes Project and Apache Healthy Stores programs. In-depth interviews, a structured survey, demonstration and feedback sessions, group activities, and meetings with key stakeholders were used to generate knowledge about the needs and resources for each community, and to obtain feedback on SLHDP interventions. First Nations communities were eager to address the increasing epidemic of diabetes. Educating children through a school prevention program was the most popular proposed intervention. Remote communities had poorer access to healthy foods and more on-reserve media and services than the smaller semi-remote reserves. While the reserves shared similar risk factors for diabetes, variations in health beliefs and attitudes and environmental conditions required tailoring of programs to each reserve. In addition, it was necessary to balance community input with proven health promotion strategies. This study demonstrates the importance of formative research in developing integrated health promotion programs for multiple communities based on previously evaluated studies.

The social context of smoking among African-American and white adolescents in Baltimore City.

OBJECTIVE: To describe and understand variations in social influences on smoking behavior among African-American and white male and female adolescents in Baltimore City, USA. DESIGN: A qualitative study where adolescents, both smokers and non-smokers, were interviewed individually (n = 21) and participated in focus groups (n = 18 focus groups, 3-10 participants per group). RESULTS: Social contexts emerged as most relevant and salient themes related to smoking behavior. White females perceived the most permissive parental messages around smoking, while males, especially African-American males, reported receiving the strictest parental sanctions. Females' need to fit in with peers contrasted with males' being coerced to smoke. Possible reasons for African-Americans' non-use of cigarettes include a desire not to disrespect parents and being turned off by parental addiction to nicotine. All adolescents cited the school's lax anti-smoking policy as a reason teens smoke at school. CONCLUSION: Interventions targeted at schools and families offer promise for reducing adolescent cigarette use.

Motivations for exercise and weight loss among African-American women: focus group results and their contribution towards program development.

OBJECTIVE: African-American women are more likely to be sedentary and maintain higher body weights compared with Caucasian women, although some are physically active and able to maintain weight loss. To develop effective intervention strategies, we need to understand why some women are successful. DESIGN: We conducted focus groups on four distinct groups of African-American women (currently physically active; currently sedentary; successful weight loss for > or = 1 year; unsuccessful weight loss) to explore motivations and intervention strategies. Open-ended questions, probes, and visual aids were used to stimulate discussions. Transcripts of sessions were read to highlight themes and concepts. RESULTS: Results indicated that motivators for the exercisers to start exercising were health concerns, weight control, stress reduction, and the influence of others. Motivators to continue exercising were feeling good and having energy. In contrast, the sedentary women reported that social support and enjoyment would be motivating. Both groups reported that physically active women conveyed the image of high energy and self-esteem. The successful weight loss women employed strategies that allowed them to eat a variety of foods and were less likely to 'diet'. The unsuccessful women referred to 'going on a diet' and were more likely to label foods as 'good' or 'bad'. They reported feeling tired and thought that losing weight would give them more energy. CONCLUSION: This information was used to develop two culturally appropriate interventions for African-American women, which is presented. Conducting formative research in study design protocols can provide an important role in intervention development.

Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands.

Formative research was conducted in the Republic of the Marshall Islands to help develop a diabetes prevention intervention. Methods included in-depth interviews, semistructured interviews, and direct observation of household behaviors in urban and remote settings. Foods were classified into two main conceptual spheres: foods from the islands/Marshallese foods and imported/American foods. Diabetes (nanimij in tonal) is a highly salient illness and is believed to be caused by foods high in fat and sugar, consumption of imported/American foods, family background, and the atomic bomb testing. Physical activity and eating a traditional diet were viewed as important for preventing diabetes. The traditional belief system links a large body with health, and a thin body with illness; however, perceptions are changing with increased acculturation and education about the health risks of obesity. These findings were used to develop a diabetes prevention home visit intervention currently being implemented and evaluated in Marshallese households.

Weight loss attempts and attitudes toward body size, eating, and physical activity in American Indian children: relationship to weight status and gender.

OBJECTIVE: This study examined dieting, weight perceptions, and self-efficacy to eat healthy foods and engage in physical activity and their relationships to weight status and gender among American Indian elementary schoolchildren. RESEARCH METHODS AND PROCEDURES: Data for this study were collected as part of the baseline examination for the Pathways study. Participants were 1441 second- through third-grade American Indian children in 41 schools representing seven tribes in Arizona, New Mexico, and South Dakota who filled out a questionnaire and had heights and weights taken. RESULTS: Forty-two percent of the children were overweight or obese. No differences were found between overweight/obese and normal weight children for healthy food intentions or self-efficacy. Heavier children (especially those with body mass index > 95th percentile) were more likely to have tried to lose weight or were currently trying to lose weight. No gender differences were found. Normal weight children chose a slightly heavier body size as most healthy compared with overweight/obese children. DISCUSSION: The results indicate that children are concerned about their weight and that weight modification efforts are common among overweight American Indian children. School, community, and family-based programs are needed to help young people adopt lifelong healthful eating and physical activity practices.

Comparison of visual estimates of children's portion sizes under both shared-plate and individual-plate conditions.

OBJECTIVE: This paper compares the accuracy of visual estimations of children's food intake in settings where several children eat together off 1 plate vs individual-plate eating scenarios. DESIGN: Eight trained observers were tested in their ability to estimate food portions consumed by children enacting common eating scenarios. Foods were categorized by food group and according to their presentation by individual-plate and shared-plate. Observed food weight estimates were compared to actual weights. SUBJECTS/SETTING: The 8 observers visually estimated 69 food portions of children eating alone and 26 portions where children were eating from a shared plate. This study was carried out in Sarlahi District, a rural, central lowland region of Nepal. STATISTICAL ANALYSES: Pearson's correlation coefficients were calculated to examine associations between estimated and actual weights. A fixed effects model was constructed to compare observers. RESULTS: Analyses revealed that observer estimates of food weights under field conditions were well correlated with actual weights for individual-plate (r = 0.89) and for shared-plate (r = 0.84) scenarios. Observers estimated food weights when children ate together on a shared plate less accurately than they did in settings where children ate alone. With the exception of 1 observer, observers did not differ significantly in their ability to estimate food weights. Accuracy of estimations was influenced by food weight with greater error associated with food quantities of less than 70 g. CONCLUSIONS: Visual estimation is a relatively accurate, valid method of assessing child food intake under rural field conditions, and the only method to obtain accurate information on dietary intake in regions where shared-plate eating is frequent.