Dairy intensification in developing countries: effects of market quality on farm-level feeding and breeding practices.

Smallholder dairy production represents a promising income generating activity for poor farmers in the developing world. Because of the perishable nature of milk, marketing arrangements for collection, distribution and sale are important for enhanced livelihoods in the smallholder dairy sector. In this study we examined the relationship between market quality and basic feeding and breeding practices at farm level. We define market quality as the attractiveness and reliability of procurement channels and associated input supply arrangements. We took as our study countries, India with its well-developed smallholder dairy sector, and Ethiopia where the smallholder dairy industry has remained relatively undeveloped despite decades of development effort. We conducted village surveys among producer groups in 90 villages across three States in India and two Regions in Ethiopia. Producer groups were stratified according to three levels of market quality - high, medium and low. Data showed that diet composition was relatively similar in India and Ethiopia with crop residues forming the major share of the diet. Concentrate feeding tended to be more prominent in high market quality sites. Herd composition changed with market quality with more dairy (exotic) cross-bred animals in high market quality sites in both India and Ethiopia. Cross-bred animals were generally more prominent in India than Ethiopia. Herd performance within breed did not change a great deal along the market quality gradient. Parameters such as calving interval and milk yield were relatively insensitive to market quality. Insemination of cross-bred cows was predominantly by artificial insemination (AI) in India and accounted for around half of cross-bred cow inseminations in Ethiopia. Data on perceptions of change over the last decade indicated that per herd and per cow productivity are both increasing in high market quality sites with a more mixed picture in medium and low-quality sites. Similarly dairy-derived income is on the increase in high market quality sites. This is accompanied by a strong increase in stall feeding at the expense of grazing. The study indicates that the first constraint to intensification of dairy production in Ethiopia is the genetic quality of the herd. There is less scope for improved AI provision in India since the cross-bred herd is mainly serviced by AI already. However, as for Ethiopia, there is considerable scope for closing yield gaps in India through improved feed use and supply. Results strongly show that well-developed markets with good procurement arrangements are key for sustainable dairy intensification.

Pathways: a culturally appropriate obesity-prevention program for American Indian schoolchildren.

Pathways, a culturally appropriate obesity prevention study for third-, fourth-, and fifth-grade American Indian schoolchildren includes an intervention that promotes increased physical activity and healthful eating behaviors. The Pathways intervention, developed through a collaboration of universities and American Indian nations, schools, and families, focuses on individual, behavioral, and environmental factors and merges constructs from social learning theory with American Indian customs and practices. We describe the Pathways program developed during 3 y of feasibility testing in American Indian schools, with special emphasis on the activities developed for the third grade; review the theoretical and cultural underpinnings of the program; outline the construction process of the intervention; detail the curriculum and physical education components of the intervention; and summarize the formative assessment and the school food service and family components of the intervention.

Pathways family intervention for third-grade American Indian children.

The goal of the feasibility phase of the Pathways family intervention was to work with families of third-grade American Indian children to reinforce health behaviors being promoted by the curriculum, food service, and physical activity components of this school-based obesity prevention intervention. Family behaviors regarding food choices and physical activity were identified and ranked according to priority by using formative assessment and a literature review of school-based programs that included a family component. The family intervention involved 3 primary strategies designed to create an informed home environment supportive of behavioral change: 1) giving the children "family packs" containing worksheets, interactive assignments, healthful snacks, and low-fat tips and recipes to take home to share with their families; 2) implementing family events at the school to provide a fun atmosphere in which health education concepts could be introduced and reinforced; and 3) forming school-based family advisory councils composed of family members and community volunteers who provided feedback on Pathways strategies, helped negotiate barriers, and explored ideas for continued family participation. For strategy 2, a kick-off Family Fun Night provided a series of learning booths that presented the healthful behaviors taught by Pathways. At an end-of-year Family Celebration, a healthy meal was served, students demonstrated newly learned Pathways activities, and certificates were presented in recognition of completion of the Pathways curriculum. Based on evaluation forms and attendance rosters, strategies 1 and 2 were more easily implemented and better received than strategy 3. Implications for developing family involvement strategies for intervention programs are discussed.

Development of a primary prevention program: insight gained in the Zuni Diabetes Prevention Program.

Diabetes prevention programs are essential in Native American communities that are experiencing high rates of non-insulin dependent diabetes mellitus (NIDDM). These programs must be community based and supported in order to succeed. The Zuni Diabetes Prevention Program (Program) is a community-based primary prevention project designed to reduce the prevalence of diabetes risk factors among high-school-age youths. The Program strives to enhance knowledge of diabetes and to support increased physical activity, increased fruit and vegetable intake, and reduced soft drink consumption. The primary mechanisms of intervention are diabetes education, a school-based wellness center, supportive social networks, and modification of the food supply available to teens. Program evaluation uses a multiple cross-sectional model; assessment occurs at three points within the 4-year project. Midproject results indicate a significant reduction in soft drink consumption and an increase in glucose/insulin ratios, suggesting a decline in the incidence of hyperinsulinemia.

Use of a food frequency questionnaire to screen for dietary eligibility in a randomized cancer prevention phase III trial.

Cancer prevention clinical trials use food frequency questionnaires (FFQs) to assist in eligibility screening. FFQ reliability and validity studies are available, but these studies do not evaluate FFQs as screening tools. The Wheat Bran Fiber Trial of the University of Arizona used a FFQ as an eligibility screen with the goal of screening out subjects whose true daily calcium intake was less than 500 mg per day (for safety) and whose true dietary fiber intake was greater than 30 g per day (for safety and trial efficiency). Subjects ineligible by FFQ were interviewed for final dietary eligibility determinations. A study was undertaken within the Wheat Bran Fiber Trial to evaluate the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of the FFQ used in this context. Four-day food records were collected on 183 potential participants before entry into the study. Using the 4-day averages as the "true" value, sensitivity, specificity, positive predictive value, and NPV were calculated for men and women separately under two screening conditions: using the target calcium and dietary fiber values and using "revised" values identified in interim analysis within the study. NPV was acceptable in all analyses. Sensitivity for low calcium intake was inadequate under the original criteria (0.33 for men and 0.09 for women) but acceptable under the revised criteria (0.80 for men and 0.81 for women). With the revised criteria, specificity declined, resulting in heavy screening burdens deemed worthwhile for the safety considerations. Dietary fiber eligibility screening worked well at target values. These differences were not predicted by reliability/validity studies.

Development of culturally competent food-frequency questionnaires.

Health-related behaviors, including food choices, are culturally determined. Culture is the medium through which people interpret their world and the tool individuals use to guide decisions. Recognition of the effect of culture on health-related behaviors has led public health investigators, including nutritionists, to address the concepts of cultural relevancy as applied to intervention strategies and assessment techniques. Drawing on a project involving the development of food-frequency questionnaires for Native American communities, I provide definitions of cultural awareness, cultural sensitivity, cultural appropriateness, and cultural competency. Cultural competency, which involves working within the cultural context of a culturally distinct population, is the approach most likely to reduce miscommunication between investigators and participants and to yield reliable and valid data. Step-by-step guidelines for creating a culturally competent food-frequency questionnaire have been developed.

Four Corners Research Consortium for Native Americans and cancer research.

Cancer morbidity and mortality in Native Americans in the Southwestern four-corners region of the United States (Arizona, Colorado, New Mexico, and Utah) is of critical concern to public health workers, health care providers, cancer researchers, and Native American communities of the region. As a follow-up to the national conference in Seattle, Washington, representatives from the Arizona, Colorado, New Mexico, and Utah Cancer Centers, the AMC Cancer Research Center, and the Indian Health Service participated in a regional conference on September 26, 1995. The primary reason for the "Four Corners Consortium" meeting was to assess cancer research activities in each state and to determine how Native American cancer research could be organized in the four-state region. One interest of the group was to determine strategies to explore why some cancers are more or less prevalent among Southwest Native American populations and to evaluate how the group might jointly establish research that would address the cancer needs of Southwestern tribes.

Alcohol consumption and its effect on the dietary patterns of Hualapai Indian women.

Studies of Native American diet have ignored the nutritional and dietary effects of alcohol consumption. Studies of Native American alcohol consumption have largely ignored the socioeconomic characteristics and drinking behaviors of women. Seven-day 24-hour dietary recalls collected from 28 Hualapai Indian women revealed that 12 participants (43%) drank alcoholic beverages. Drinkers frequently skipped meals, yet maintained an energy intake higher than non-drinkers by consuming high calorie alcoholic and non-alcoholic beverages and by eating large restaurant meals. Despite energy intake differences, drinkers and non-drinkers did not differ in body weight or percent body fat. Drinkers were not at risk for protein malnutrition as reported for other female drinkers, but Hualapais' tendency to fast while drinking may increase their risk of liver disease. In contrast to reports of Native American males, female drinkers in this sample were often high school graduates with full-time jobs.

Diet and activity patterns of male and female co-workers: should worksite health promotion programs assume homogeneity?

Worksite health promotion programs address the health education needs of the average employee. Anthropometric measurements and 24h diet and activity diaries collected from co-workers reveal that lifestyle and subsequently, health education needs of men and women working for the same employer, in the same environment and performing similar tasks, may be different. In this study, males were marginally overweight and obese; females were within recommended limits. Although job related workloads were comparable, females were more active (24hEE/FFM) outside the work place. Females spent more time engaged in moderate weight-bearing domestic activities than did males. These results question the effectiveness of worksite health promotion program which ignore the different health education needs of male and female employees.

Patterns of food use and nutrient intake of obese and non-obese Hualapai Indian women of Arizona.

To document patterns of food use and nutrient intake associated with obesity in Native American women, a sample of 14 obese and 14 non-obese free-living Hualapai Indian women living in northwest Arizona was studied. Patterns of food use were determined through long-term observation, dietary histories, and 24-hour dietary recalls. Dietary intake was determined through 24-hour dietary recalls over 7 consecutive days. Patterns of food acquisition, selection, and preparation were similar for obese and non-obese Hualapai women. The diets of both groups were dominated by nonalcoholic beverages, potatoes, beans, white wheat flour, and canned goods. Wild and locally cultivated foods were not eaten on a regular basis. The diets of both the obese and non-obese women were high in energy (pooled mean +/- standard deviation [SD] = 2,602 +/- 766 kcal/day) and carbohydrates (pooled mean +/- SD = 333.4 +/- 95.6 gm/day), moderate in protein (pooled mean +/- SD = 77.8 +/- 20.9 gm/day) and fat (pooled mean +/- SD = 101.1 +/- 25.4 gm/day), and low in crude fiber (pooled mean +/- SD = 4.7 +/- 2.0 gm/day). The study indicates that significantly (p less than .001) higher energy intakes of the obese women can be attributed to their greater consumption of nonalcoholic and alcoholic beverages.