Review of evaluation tools used to assess the impact of nutrition education on dietary intake and quality, weight management practices, and physical activity of low-income audiences.

Nutrition education programs and social marketing campaigns frequently focus on low-income audiences with the goal of improving dietary intake and quality, weight management practices, and physical activity. The impact of nutrition education can be assessed by measuring change in relation to any or all of these broad variables. Unfortunately, little information is available concerning the reliability, validity, and sensitivity to change of measures used to assess these constructs with low-income audiences of adults and adolescents. This article reviews the literature and discusses the types of available measures that have been used and evaluated for the above audiences. It describes specific measures used to assess total diet, consumption of food groups from the Food Guide Pyramid, and behaviors related to weight management and physical activity. Overall, this review suggests that there is a critical need for additional development and evaluation of dietary quality measurement tools for low-income and minority audiences.

Family planning clinic patients: their usual health care providers, insurance status, and implications for managed care.

PURPOSE: To understand the extent to which family planning clinic patients have health insurance or access to other health care providers, as well as their preferences for clinic versus private reproductive medical care. METHOD: An anonymous self-report questionnaire was administered at three Planned Parenthood clinics in Los Angeles County to 780 female patients aged 12-49 years. Dependent variables included insurance status, usual source of care, and a battery of questions regarding the importance of confidentiality. RESULTS: A total of 356 adolescents (aged 12-19 years) and 424 adults (aged 20-49 years) completed the survey in 1994. Fifty-nine percent of adolescents and 53% of adults had a usual source of care other than the clinic. The majority of each group reported some degree of continuity of care in their usual provider setting. Nearly half (49%) of all adolescents had health insurance compared with 27% of adults. Adolescents cited not wanting to involve family members as the primary reason for not using their usual providers, whereas adults were more likely to cite being uninsured. The majority of both adult and adolescent patients indicate they would prefer the clinic over private health care if guaranteed health care that was free, confidential, or both. CONCLUSION: Despite many patients' having health insurance and other sources of health care, family planning clinics were primarily chosen because of cost and confidentiality. Their reasons for preferring clinics may continue despite changes in access to insurance or efforts to incorporate similar reproductive services into mainstream health care provider systems. Making public or private health care funds available to family planning clinics through contracts or other mechanisms may facilitate patients' access to essential services and reduce potential service duplication.

Involving parents in cancer risk reduction: a program for Hispanic American families.

The authors explored changes in dietary behavior, nutrition knowledge, and parental support among inner-city, low-income, Hispanic American families. Thirty-eight families were randomly assigned to receive a 12-week, culture-specific dietary intervention or be in a control group. Results showed that parental support was related to changes in diet, nutrition knowledge, and attendance for both mothers and children. Dietary behavior changes (e.g., reduction in dietary fat) were seen only in the treatment group. Distribution of health-related pamphlets to the control group may have promoted cognitive changes (e.g., increased nutrition knowledge) seen in this low-literacy sample. Further research is needed to document behavioral changes after ethnic-specific interventions and the maintenance of those changes over time.

High-risk nutrient intakes among low-income Mexican women in Chicago, Illinois.

OBJECTIVES: The Cross-sectional Cooking, Eating, Nutrition, and Shopping (CENAS) Survey was used to obtain data on food consumption patterns of low-income Mexicans living in Chicago, Ill. DESIGN: As part of the CENAS Survey, 186 Mexican women provided 24-hour dietary recall data. OUTCOME MEASURES: Distributions of macronutrient and micronutrient intakes were determined. The proportions of CENAS Survey participants achieving the National Heart Association and National Cancer Institute dietary guidelines were calculated. Intakes of Mexican women in Chicago were compared with intakes of Mexican women of similar socioeconomic status in Texas, Mexican-American women participating in phase 1 of the third National Health and Nutrition Examination Survey (1988-1991), and Mexican-American women participating in the Hispanic Health and Nutrition Examination Survey (1982-1984). STATISTICAL ANALYSIS: Tests were used to compare the nutrient intakes of CENAS Survey respondents with published results from other studies. RESULTS: The proportion of respondents reporting intakes less than two thirds of Recommended Dietary Allowances for nine micronutrients ranged from 11% (thiamin and riboflavin) to 82% (folacin). Respondents also reported median fat (34% of energy) and fiber (16.9 g/day) intakes that departed from recommendations to reduce the risk of heart disease and cancer. APPLICATIONS AND CONCLUSIONS: Half or more of the Mexican women interviewed in Chicago reported inadequate consumption of calcium, folate, zinc, and iron; higher than recommended intakes of fats; and lower than recommended intakes of fiber, indicating the need for nutrition education and intervention. Their nutrient consumptions differed significantly from those of Mexican-American women in the United States, suggesting possible regional or temporal variation in dietary patterns and underscoring the need for population-specific interventions.

Beta-carotene decreases markers of lipid peroxidation in healthy volunteers.

We previously showed that daily intake of beta-carotene, a nontoxic antioxidant, reduces lipid peroxidation as assessed by serum lipid peroxide levels. An alternative method to detect lipid peroxidation is the measurement of pentane in breath. Pentane is a five-carbon hydrocarbon that is released when an omega-6 unsaturated fatty acid undergoes peroxidation. The aim of this study was to see whether graded doses of beta-carotene would affect breath pentane excretion in normal subjects placed on a carotenoid-free liquid diet for two weeks. The subjects were then repleted with either 15 (n = 7) or 120 mg (n = 8) of beta-carotene daily for four weeks while continuing the same diet. Serum beta-carotene and breath pentane were measured before and after beta-carotene refeeding. Lipid peroxidation, as assessed by gas-chromatographic measurement of breath pentane, was significantly (p < 0.05) reduced by daily supplements of 120 mg beta-carotene (from 3.7 +/- 0.9 to 2.2 +/- 1.4 nmol/l). However, the decline in pentane exhalation observed with the 15-mg beta-carotene dose did not achieve statistical significance (p = 0.13).

Oral diet does not alter pulmonary pentane or ethane excretion in healthy subjects.

Ethane and pentane are alkanes that are excreted through the lungs to a small degree in healthy subjects. These gasses are produced from the peroxidation of unsaturated fats which are found both in body tissues and in foods. These gasses are excreted in larger amounts by patients with increased production of reactive oxygen metabolites, including those with inflammation or ischemia. Thus, detection of these gasses in excessive quantities is considered evidence for lipid peroxidation. However, the effects of dietary factors on these measurements have not been defined. To define the effects of eating on the pulmonary excretion of these alkanes, 29 healthy subjects were fed a standardized liquid diet (1060 kcal, 12.9 g linoleic acid and 385 mg linolenic acid) after an overnight fast. Breath alkanes were measured at 0, 1, 3, and 6 hours. All subjects had normal vitamin E (1.11 + 0.26 mg/dl), retinol (64 +/- 14 micrograms/dl), beta carotene (27 +/- 21 micrograms/dl), lycopene (23 +/- 12 micrograms/dl) and zinc (81.9 +/- 13.5 micrograms/dl) levels. No statistically significant changes in either alkane were noted relative to the fasting level. We conclude that oral diet does not alter pulmonary ethane or pentane excretion in healthy subjects.

Serum time curve characteristics of a fixed dose of beta-carotene in young and old men.

The present study was designed to evaluate age-related differences in serum beta-carotene time curve response characteristics when a beta-carotene dose was given in conjunction with 1500 kcal over the course of a day. On two consecutive days, seven old (73 +/- 4 years) and six young (24 +/- 1 years) men were each fed three 500-kcal meals of an isotonic liquid formula diet containing only trace amounts of beta-carotene. On the first day of testing, no supplemental beta-carotene was given (baseline day). A 15 mg dose of beta-carotene was fed with the morning meal on the second day (test dose day). Fasting blood and hourly blood samples were obtained for 8 consecutive hours on both days. Additional blood was drawn 24 and 48 hours after the test beta-carotene dose. There were no statistical differences in baseline beta-carotene concentrations between the two age groups tested, but, because of high individual variability, serum time curve characteristics were adjusted for fasting beta-carotene levels. After adjustment, the postdose serum beta-carotene response was two to three times greater (p less than or equal to 0.04) in young subjects, as evaluated by peak concentration, area under the curve, or ascending slope of the serum response curve. Examination of factors besides age group that may have accounted for these results suggests that the serum response of the elderly may be more a function of body composition and/or serum lipid patterns than of age per se. However, in the present US population, it may not be valid to control for these factors, which are both closely related to aging.

Acquired immunodeficiency syndrome and adolescents. Knowledge, attitudes, and behaviors of runaway and homeless youths.

OBJECTIVE: To describe the knowledge, attitudes, and behaviors of runaway and homeless youths regarding infection with the human immunodeficiency virus (HIV). DESIGN: Cross-sectional, descriptive. SETTING: A crisis shelter for runaway and homeless youths. PARTICIPANTS: One hundred one residents, aged 13 to 20 years, of a shelter for homeless and runaway youths in Houston, Tex. INTERVENTION: None. MEASUREMENTS/MAIN RESULTS: A self-administered questionnaire was used to examine the knowledge, attitudes, and behaviors of these youths regarding infection with HIV. Nearly one fourth had injected illegal drugs; one fifth had shared needles for other purposes. Sixteen percent had had anal intercourse, 19% had engaged in prostitution, and 67% of all subjects reported having four or more sexual partners. One fifth reported that they always use condoms. While quite knowledgeable about means of transmission, they held prevalent misconceptions about casual contact and risk reduction. Youths perceive few barriers to condom use, have fairly high intentions to practice preventive behavior, and have high self-efficacy to do so. Most believe they are at little or no risk for acquiring HIV. These findings support the need for medical, educational, and social service programs to reduce the risk of HIV among these youths. CONCLUSION: Runaway and homeless youths practice behaviors that place them at high risk for acquisition of HIV infection. Risk reduction is imperative and will require programs that address the educational, psychological, social, and medical needs of these youths.

Effects of beta-carotene repletion on beta-carotene absorption, lipid peroxidation, and neutrophil superoxide formation in young men.

The chemopreventive effects of beta-carotene are usually attributed to its antioxidant properties. To determine the effects of beta-carotene supplementation on different parameters of oxidative metabolism, 15 normal young male subjects (18-30 yrs) were placed on a carotenoid-free liquid diet for two weeks prior to entry into the study. Blood was then measured for five carotenoids, retinol, retinyl palmitate, retinol-binding protein, alpha-tocopherol, vitamin C, zinc, lipid peroxides, and neutrophil superoxide production. Absorption tests were performed with 15 mg of beta-carotene to determine absorption curves for each subject. Subjects were then divided into two groups and given either 15 (n = 7) or 120 (n = 8) mg of beta-carotene daily for four weeks along with the same carotenoid-free liquid diet. The absorption test and the blood measurements were repeated. After repletion with beta-carotene, serum lipid peroxide levels decreased in both groups (p less than 0.05), but no other changes were noted in either the neutrophil superoxide production or in the levels of any of the vitamins measured. In contrast to vitamin E, the superoxide scavenging ability of beta-carotene apparently does not contribute to its effects in lowering serum lipid peroxide levels.

Normal serum response to oral beta-carotene in humans.

This study was performed to determine (1) the normal serum response to a single oral dose of beta-carotene (BC), (2) the effect of meal timing and serum response to meal lipids on serum BC, (3) the effect of administered BC on other serum carotenoids and retinoids, and (4) the relationship of body composition to serum BC response. Subjects consumed one BC dose with a liquid 500 kcal BC-free diet; fasting and hourly venous blood was collected for 8 hours and again at 24 hours. A second liquid BC-free meal was consumed 4 hours post-dosing; this midday meal was omitted in some subjects. Serum BC levels rose and peaked initially at 5 hours, but continued to be absorbed in most subjects, remaining significantly elevated at 24 hours as compared to baseline values (p less than 0.001), independent of BC dose. The area under the BC absorption curve (8-hr AUC) increased linearly with BC dose and correlated positively with peak serum triglycerides (TG) after a meal (n = 26 tests, r = 0.56, p less than 0.003). Omission of the midday meal significantly delayed the initial BC peak to 7 hours (p less than 0.0004). Serum levels of retinol, alpha-carotene, cryptoxanthin, lycopene, and lutein remained unchanged. Serum retinyl esters did not rise in all subjects following BC intake; when it did, retinyl esters rose and peaked concomitantly with BC, but declined within 8 hours. There was no correlation between the initial serum BC, peak BC, 24-hr BC, 8-hr AUC, or peak serum TG and the percentage of body fat. We conclude that: (1) the timing of the serum response to oral BC is independent of dose, (2) the serum BC response is greater in those with a greater serum triglyceride response to meal lipids, (3) BC at the doses given does not alter the levels of other serum carotenoids, and (4) there is no correlation between the serum BC parameters measured and adiposity.