Home Environment-Focused Intervention Improves Dietary Quality: A Secondary Analysis From the Healthy Homes/Healthy Families Randomized Trial.

OBJECTIVE: Estimate Healthy Homes/Healthy Families (HHHF) intervention efficacy for improving dietary quality. METHODS: Low-income overweight and obese women (n = 349) recruited from rural community health centers were randomized to receive HHHF, a 16-week home environment-focused coaching intervention or health education materials by mail. Healthy Eating Index-2010 scores were calculated from 2 24-hour dietary recalls collected at baseline and 6- and 12-month follow-up. RESULTS: HHHF participants reported greater improvements in Healthy Eating Index-2010 total scores at 6-month follow-up (+3.41 ± 13.43 intervention vs +2.02 ± 12.26 control; P =.009). Subcomponent analysis indicated greater consumption of total vegetables (P = .02) and greens and beans (P = .001), whole grains (P = .02) and reduced consumption of empty calories (P = .03). Standardized intervention effect sizes were 0.16 at 6 months and 0.13 at 12 months of follow-up. CONCLUSIONS AND IMPLICATIONS: The HHHF resulted in short-term improvements in dietary quality, although more research is needed to interpret the clinical significance of effect sizes of this magnitude.

Barriers to weight loss among community health center patients: qualitative insights from primary care providers.

BACKGROUND: Community Health Centers (CHCs) are important settings for obesity prevention and control. However, few studies have explored the barriers that CHC clinicians perceive their patients face in maintaining a healthy weight. METHODS: Semi-structured in-depth interviews were conducted with thirty physicians, physician assistants, and nurse practitioners recruited from four Community Health Centers (CHCs), located in a rural, southwestern region of the state of Georgia, US. Interviews were digitally recorded, transcribed verbatim, and thematically analyzed. RESULTS: Clinicians perceived that their patients face numerous individual, interpersonal, and community-level barriers to weight loss. Perceived individual-level barriers included interrelated aspects of poverty and limited motivation to lose weight. Perceived interpersonal barriers included social and cultural norms, such as positive associations with larger body sizes, negative associations with smaller body sizes, lack of awareness of obesity as a problem, and beliefs regarding hereditary or generational body types. Perceived community-level barriers included limited healthy food options and aspects of the local food culture in the Southern US. CONCLUSIONS: Clinicians perceived that their patients face barriers to weight loss at multiple levels of the social ecology, including individual, social, and environmental factors. Results may partly explain limited provision of weight counseling in CHCs and suggest opportunities for intervention.

Jung's psychoid concept and Bion's proto-mental concept: a comparison.

Jung and Bion both developed theoretical concepts propounding a deeply unknowable area of the psyche in which body and mind are undifferentiated and the individual has no distinct identity, from which a differentiated consciousness arises. In Jung's case, this is enshrined in his psychoid concept and the associated notion of synchronicity and, in Bion's case, in his proto-mental concept and his ideas on group dynamics. It is by means of these two concepts that Jung and Bion approach and locate a combined body-mind, a monism, in which body and mind are seen as different aspects of the same thing. This paper reviews the claim that although the two concepts are associated clinically with very different situations, their commonality may arise from a similar intellectual basis: both men appear to have been influenced by the same source of vitalist ideas in philosophy including Henri Bergson, and Jung's ideas also exerted a direct influence on Bion.

The impact of home, work, and church environments on fat intake over time among rural residents: a longitudinal observational study.

BACKGROUND: Dietary behaviors are influenced by many individual and environmental factors. This study explores how dietary fat intake in high-risk midlife adults living in the rural south is influenced by three behavior settings, i.e. in the home, at work, and at church. METHODS: Self-report data were collected from rural African American or Caucasian adults age 40-70 at three time points at baseline, 6, and 12 months post baseline. Multilevel analyses investigated the impact of determinants of fat intake over time. RESULTS: Home and work environments varied significantly over time in regard to healthy eating while church environments remained stable. Age, gender, and self-efficacy for healthy eating were individual factors associated with fat intake. In the home, presence of more high fat items, a time-varying variable, was significant. In the work environment, having access to healthy foods as well as healthy eating programs has positive impact as did hearing healthy eating messages and availability of healthy foods at church. CONCLUSIONS: Understanding stability and variability of dietary fat intake from a social ecologic perspective will aid in identifying targets of change for intervention. Understanding which components of key behavior settings are dynamic and which are relatively stable will help to disentangle the complexity of multi-level determinants of dietary behavior.

Impact of Improving Home Environments on Energy Intake and Physical Activity: A Randomized Controlled Trial.

OBJECTIVES: We assessed the effectiveness of an intervention targeting home food and activity environments to reduce energy intake and increase physical activity among overweight and obese patients from 3 community health centers in rural Georgia. METHODS: We conducted a randomized controlled trial (n = 349) from 2011 to 2013, with follow-up at 6 and 12 months. Health coaches delivered the 16-week intervention by using tailored home environment profiles showing areas in need of improvement and positive aspects of the home environment, behavioral contracts for healthy actions, and mailed support materials. RESULTS: Participants were mostly African American women (84.8%), with a mean age of 50.2 years and a mean body mass index (weight in kilograms divided by the square of height in meters) of 38.3. Daily energy intake decreased more for the intervention than control group at 6 (-274 vs -69 kcal) and 12 months (-195 vs -76 kcal). We observed no change for either objective or self-reported physical activity. At 12 months, 82.6% of intervention participants had not gained weight compared with 71.4% of control participants. CONCLUSIONS: The intervention was effective in changing home environments and reducing energy intake.

Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women.

OBJECTIVES: The goal of this research was to assess the roles of demographic and home food environment characteristics on diet quality measured with the U.S. Department of Agriculture's Healthy Eating Index (HEI) in a population of low-income overweight and obese African American women. DESIGN: Cross-sectional analysis of baseline data. SETTING: A community-based study of low-income overweight and obese African American women. SUBJECTS: Participants enrolled in the Healthy Homes/Healthy Families study including a home environment survey (e.g., food availability, food practices and social support) and 24-hour recall dietary data collected on one weekday and one weekend day (n = 198). RESULTS: In multivariate regression analyses, demographic characteristics were not significantly associated with diet quality; however, several home food environment characteristics were significantly associated with higher quality diets, including healthy shopping (e.g., regularly purchasing fresh fruits and vegetables), selecting healthy beverages (e.g., without added sugar), healthy food preparation, and serving behaviors. Eating while watching television was associated with lower quality diets. Nearly 33% (p < 0.001) of the variance in HEI total score was explained by the home food environment factors, far surpassing that explained by demographic characteristics (3.5%, p = 0.21). CONCLUSIONS: Interventions targeting the home food environment may improve overall diet quality in low-income overweight African American populations.

Perceptions of social and environmental support for healthy eating and physical activity in rural southern churches.

The influence of church environments on healthy eating and physical activity was explored through in-depth interviews with rural adults aged 50-70 (n = 60). Data were analyzed using a constant comparative approach, with an emphasis on noting similarities and differences between African American and predominantly white churches. Findings suggest that church-based nutrition and exercise programs were rare, and existing recreational facilities were geared toward younger members. The majority of church leaders did not talk about nutrition or physical activity, but social support from church friends for healthy eating and physical activity was fairly common. Despite barriers to establishing healthy environments in church settings, churches are rich in social support that could be tapped to promote healthy behavior.

Jung, vitalism and 'the psychoid': an historical reconstruction.

This paper traces the history of Jung's ideas concerning the psychoid unconscious, from their origins in the work of the vitalist, Hans Driesch, and his concept of Das Psychoid, through the subsequent work of Eugen Bleuler, Director of the Burghölzli Asylum, and his concept of Die Psychoide, to the publication of Jung's paper On the Nature of the Psyche in 1947. This involves a review of Jung's early work and of his meeting with Freud, when apparently the two men discussed calling the unconscious 'psychoid', as well as a review of Jung's more mature ideas concerning a psychoid unconscious. I propose to argue that even at the time of their meeting, Jung had already formulated an epistemological approach that was significantly different from that of Freud and that clearly foreshadowed his later ideas as set out in On the Nature of the Psyche.