Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior.

OBJECTIVE: Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. DESIGN: A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. SETTING: The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. SUBJECTS: Parents of 307 pre-school children (3-5 years old). RESULTS: Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized ß=0·349, P<0·0001) and desire (standardized ß=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized ß=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized ß=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized ß=-0·133, P=0·009), autonomy (standardized ß=-0·118, P=0.014), attitude about negative effects of vegetables (standardized ß=-0·118, P=0·015) and descriptive norms (standardized ß=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. CONCLUSIONS: The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

Influence of behavioral theory on fruit and vegetable intervention effectiveness among children: a meta-analysis.

OBJECTIVE: To test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundation. DESIGN: Systematic review and meta-analysis. SETTING: Identification of articles in PubMed, PsycInfo, Medline, Cochrane Collaborative database, and existing literature reviews and meta-analyses. PARTICIPANTS: Children aged 2-18 years. INTERVENTIONS: Change in fruit and/or vegetable consumption in dietary change interventions. METHODS: Meta-analysis, meta-regression analysis, and summary reporting for articles. CONCLUSIONS AND IMPLICATIONS: Predicating an intervention on behavioral theory had a small to moderate enhancement (P < .001) of outcome effectiveness. Differences in mean Hedges' g effect sizes between theory and non-theory interventions were 0.232 for fruit, 0.043 for vegetables, and 0.333 for fruit and vegetables combined. There was mixed support, however, for enhanced dietary change with multiple theories or a formal planning process. After controlling for study quality, theory use was related only to vegetable consumption (ß = 0.373; P < .001). More research is needed on theory's influences on dietary behaviors to guide future interventions among children. More research is also needed to identify what may be effective practical- or experience-based procedures that complement theory, to incorporate into interventions.

Dimensions of vegetable parenting practices among preschoolers.

The objective of this study was to determine the factor structure of 31 effective and ineffective vegetable parenting practices used by parents of preschool children based on three theoretically proposed factors: responsiveness, control and structure. The methods employed included both corrected item-total correlations and confirmatory factor analysis. Acceptable fit was obtained only when effective and ineffective parenting practices were analyzed separately. Among effective items the model included one second order factor (effectiveness) and the three proposed first order factors. The same structure was revealed among ineffective items, but required correlated paths be specified among items. A theoretically specified three factor structure was obtained among 31 vegetable parenting practice items, but likely to be effective and ineffective items had to be analyzed separately. Research is needed on how these parenting practices factors predict child vegetable intake.

Predicting Use of Ineffective Responsive, Structure and Control Vegetable Parenting Practices with the Model of Goal Directed Behavior.

This study reports the modeling of three categories of ineffective vegetable parenting practices (IVPP) separately (responsive, structure, and control vegetable parenting practices). An internet survey was employed for a cross sectional assessment of parenting practices and cognitive-emotional variables. Parents (n=307) of preschool children (3-5 years old) were recruited through announcements and postings. Models were analyzed with block regression and backward deletion procedures using a composite IVPP scale as the dependent variable. The independent variables included validated scales from a Model of Goal Directed Vegetable Parenting Practices (MGDVPP), including: intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioral control, and anticipated emotions. The available scales accounted for 26.5%, 16.7% and 44.6% of the variance in the IVPP responsive, structure and control subscales, respectively. Different sets of diverse variables predicted the three IVPP constructs. Intentions, Habits and Perceived Behavioral Control were strong predictors for each of the IVPP constructs, but the subscales were specific to each IVPP construct. Parent emotional responses, an infrequently investigated variable, was an important predictor of ineffective responsive vegetable parenting practices and ineffective structure vegetable parenting practices, but not ineffective control vegetable parenting practices. An Attitude subscale and a Norms subscale predicted ineffective responsive vegetable parenting practices alone. This was the first report of psychometrically tested scales to predict use of IVPP subscales. Further research is needed to verify these findings in larger longitudinal cohorts. Interventions to increase child vegetable intake may have to reduce IVPP.

The Children's Behavior Questionnaire very short scale: psychometric properties and development of a one-item temperament scale.

Little research has been conducted on the psychometrics of the very short scale (36 items) of the Children's Behavior Questionnaire, and no one-item temperament scale has been tested for use in applied work. In this study, 237 United States caregivers completed a survey to define their child's behavioral patterns (i.e., Surgency, Negative Affectivity Effortful Control) using both scales. Psychometrics of the 36-item Children's Behavior Questionnaire were examined using classical test theory, principal factor analysis, and item response modeling. Classical test theory analysis demonstrated adequate internal consistency and factor analysis confirmed a three-factor structure. Potential improvements to the measure were identified using item response modeling. A one-item (three response categories) temperament scale was validated against the three temperament factors of the 36-item scale. The temperament response categories correlated with the temperament factors of the 36-item scale, as expected. The one-item temperament scale may be applicable for clinical use.

6-n-propylthiouracil taster status not related to reported cruciferous vegetable intake among ethnically diverse children.

Sensitivity to the taste of 6-n-propylthiouracil (PROP) (a bitter chemical related to the phenylthiocarbamide found in cruciferous vegetables) has been related to dietary intake or preferences of cruciferous vegetables among adults and young children but not middle-aged children or adolescents. We hypothesized that PROP taste sensitivity is related to lower reported dietary intake of cruciferous vegetables, primarily among younger children (ie, a moderating effect of child age). This study examined the relationship of PROP sensitivity to reported dietary intake across 3 days in 2 age groups of youth (9-10 and 17-18 years) while statistically controlling for physical activity, social desirability, and reporting bias. Cross-sectional design was used with a multiethnic (white, African American, Hispanic, etc) sample of 843 men and women. Children were recruited from and data were collected in local elementary and high schools that had at least 30% ethnic minority enrollment. Children providing nonplausible reports of dietary intake were deleted from the analyses. Body mass index was calculated and expressed in z scores. Energy intake and physical activity were measured by 3 telephone-conducted 24-hour dietary recalls with the Nutrient Data System for Research and 5 days of Actigraph (ActiGraph, Shalimar, Florida) activity monitor. The primary analyses included 347 students. 6-n-Propylthiouracil sensitivity was not related to intake of cruciferous vegetables. Intakes of the cruciferous vegetables were low, which may explain the lack of relationship.

Children's accuracy of portion size estimation using digital food images: effects of interface design and size of image on computer screen.

OBJECTIVE: To test the effect of image size and presence of size cues on the accuracy of portion size estimation by children. DESIGN: Children were randomly assigned to seeing images with or without food size cues (utensils and checked tablecloth) and were presented with sixteen food models (foods commonly eaten by children) in varying portion sizes, one at a time. They estimated each food model's portion size by selecting a digital food image. The same food images were presented in two ways: (i) as small, graduated portion size images all on one screen or (ii) by scrolling across large, graduated portion size images, one per sequential screen. SETTING: Laboratory-based with computer and food models. SUBJECTS: Volunteer multi-ethnic sample of 120 children, equally distributed by gender and ages (8 to 13 years) in 2008-2009. RESULTS: Average percentage of correctly classified foods was 60·3 %. There were no differences in accuracy by any design factor or demographic characteristic. Multiple small pictures on the screen at once took half the time to estimate portion size compared with scrolling through large pictures. Larger pictures had more overestimation of size. CONCLUSIONS: Multiple images of successively larger portion sizes of a food on one computer screen facilitated quicker portion size responses with no decrease in accuracy. This is the method of choice for portion size estimation on a computer.

Components of the diet associated with child adiposity: a cross-sectional study.

OBJECTIVE: This study sought to determine which components of youths' diets were related to adiposity while controlling for potential often-neglected confounders such as moderate to vigorous physical activity (MVPA) and dietary reporting error. Secondary goals of this study were to determine the extent to which MVPA confounded the associations between diet and adiposity and whether associations between diet and adiposity would differ depending on reporting error. METHODS: An ethnically diverse urban sample of 342 children aged 9-10 years and 323 adolescents aged 17-18 years were recruited for this cross-sectional study. Body mass index (BMI) and waist circumference (WC) were measured in the school; dietary assessment included three 24-hour recalls via telephone in the evenings, and MVPA assessment included 5 days of accelerometry. Over (n = 68), under (n = 250), or plausible (n = 347) dietary intake reporters were identified with the Huang calculation method. Linear regression assessed the relationship between adiposity indicators (BMI z-score and WC) and components of the diet (energy intake, food groups, macronutrients) after controlling for reporting error, demographic variables, and MVPA. RESULTS: When dietary reporting error and potential confounders such as MVPA and demographic variables were controlled, energy intake (EI), vegetables, refined grains, total fat, total protein, and total carbohydrate were positively related to BMI z-score and WC and artificially sweetened beverages to WC. MVPA was a significant confounder. For BMI z-score, but not WC, relationships and strength of these relationships differed depending on dietary reporting error group (plausible, underreporter, overreporter). CONCLUSIONS: Among plausible reporters, as expected, EI, refined grains, and all macronutrients were positively related to adiposity; however, artificially sweetened beverages and vegetables, which are low-energy-dense foods, were also positively related to adiposity. Reporting error interfered with associations between diet and BMI z-score but not WC, suggesting WC is a more robust measure of adiposity in relation to diet.

Self efficacy for fruit, vegetable and water intakes: Expanded and abbreviated scales from item response modeling analyses.

OBJECTIVE: To improve an existing measure of fruit and vegetable intake self efficacy by including items that varied on levels of difficulty, and testing a corresponding measure of water intake self efficacy. DESIGN: Cross sectional assessment. Items were modified to have easy, moderate and difficult levels of self efficacy. Classical test theory and item response modeling were applied. SETTING: One middle school at each of seven participating sites (Houston TX, Irvine CA, Philadelphia PA, Pittsburg PA, Portland OR, rural NC, and San Antonio TX). SUBJECTS: 714 6th grade students. RESULTS: Adding items to reflect level (low, medium, high) of self efficacy for fruit and vegetable intake achieved scale reliability and validity comparable to existing scales, but the distribution of items across the latent variable did not improve. Selecting items from among clusters of items at similar levels of difficulty along the latent variable resulted in an abbreviated scale with psychometric characteristics comparable to the full scale, except for reliability. CONCLUSIONS: The abbreviated scale can reduce participant burden. Additional research is necessary to generate items that better distribute across the latent variable. Additional items may need to tap confidence in overcoming more diverse barriers to dietary intake.

6-n-Propylthiouracil sensitivity and obesity status among ethnically diverse children.

OBJECTIVE: To examine the relationship of 6-n-propylthiouracil (PROP) sensitivity to BMI while statistically controlling for demographic characteristics in two age groups of children: 9-10 years and 17-18 years (n 1551). DESIGN: Cross-sectional design with a multi-ethnic (White, African-American, Hispanic, Other) sample of 813 children aged 9-10 years and 738 children aged 17-18 years. Children were recruited from local elementary and high schools with at least 30 % minority ethnic enrolment. Children's height, weight and waist circumference were measured along with their PROP taster status. PROP was measured using two paper discs, one impregnated with NaCl (1.0 mol/l) and the other with PROP solution (0.50 mmol/l). RESULTS: A significant PROP sensitivity by socio-economic status (SES) interaction term (P = 0.010) was detected wherein supertasters had the largest BMI percentile and Z-score, but only among the group with highest SES. CONCLUSIONS: The results suggest that other factors overwhelmed the influence of PROP sensitivity on adiposity in lower-SES groups. The percentage of variance accounted for by the interaction term was about 1 %. Thus, PROP supertasters had the largest BMI percentile and Z-score, but only among the highest-SES group.

Parenting practices are associated with fruit and vegetable consumption in pre-school children.

OBJECTIVE: Parents may influence children's fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children. DESIGN: An exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004-5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children's consumption of F&V, after controlling for potential confounding factors. RESULTS: A three-cluster solution provided the best fit (R2 = 0.62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments' practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized beta = 0.09, P < 0.1; final model R2 = 0.17) after controlling for confounders, including parental feeding styles. CONCLUSIONS: Parents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children's F&V intake.

Development of new physical activity and sedentary behavior change self-efficacy questionnaires using item response modeling.

BACKGROUND: Theoretically, increased levels of physical activity self-efficacy (PASE) should lead to increased physical activity, but few studies have reported this effect among youth. This failure may be at least partially attributable to measurement limitations. In this study, Item Response Modeling (IRM) was used to develop new physical activity and sedentary behavior change self-efficacy scales. The validity of the new scales was compared with accelerometer assessments of physical activity and sedentary behavior. METHODS: New PASE and sedentary behavior change (TV viewing, computer video game use, and telephone use) self-efficacy items were developed. The scales were completed by 714, 6th grade students in seven US cities. A limited number of participants (83) also wore an accelerometer for five days and provided at least 3 full days of complete data. The new scales were analyzed using Classical Test Theory (CTT) and IRM; a reduced set of items was produced with IRM and correlated with accelerometer counts per minute and minutes of sedentary, light and moderate to vigorous activity per day after school. RESULTS: The PASE items discriminated between high and low levels of PASE. Full and reduced scales were weakly correlated (r = 0.18) with accelerometer counts per minute after school for boys, with comparable associations for girls. Weaker correlations were observed between PASE and minutes of moderate to vigorous activity (r = 0.09 - 0.11). The uni-dimensionality of the sedentary scales was established by both exploratory factor analysis and the fit of items to the underlying variable and reliability was assessed across the length of the underlying variable with some limitations. The reduced sedentary behavior scales had poor reliability. The full scales were moderately correlated with light intensity physical activity after school (r = 0.17 to 0.33) and sedentary behavior (r = -0.29 to -0.12) among the boys, but not for girls. CONCLUSION: New physical activity and sedentary behavior change self-efficacy scales have fewer items than classical test theory derived alternatives and have reasonable validity for boys, but more work is needed to develop comparable scales for girls. Fitting the items to a underlying variable could be useful in tailoring interventions to this scale.

Distance to food stores & adolescent male fruit and vegetable consumption: mediation effects.

BACKGROUND: The physical environments in which adolescents reside and their access to food stores may influence their consumption of fruit and vegetables. This association could either be direct or mediated via psychosocial variables or home availability of fruit and vegetables. A greater understanding of these associations would aide the design of new interventions. The purpose of this study was to examine associations between distance to food stores and restaurants and fruit and vegetable consumption and the possible mediating role of psychosocial variables and home availability. METHODS: Fruit and vegetable consumption of 204 Boy Scouts was assessed by a food frequency questionnaire in 2003. Participant addresses were geo-coded and distance to different types of food stores and restaurants calculated. Fruit and vegetable preferences, home availability and self-efficacy were measured. Regression models were run with backward deletion of non-significant environmental and psychosocial variables. Mediation tests were performed. RESULTS: Residing further away from a small food store (SFS) (convenience store and drug store) was associated with increased fruit and juice and low fat vegetable consumption. Residing closer to a fast food restaurant was associated with increased high fat vegetable and fruit and juice consumption. Vegetable preferences partially mediated (26%) the relationship between low fat vegetable consumption and distance to the nearest SFS. CONCLUSION: Distance to SFS and fast food restaurants were associated with fruit and vegetable consumption among male adolescents. Vegetable preferences partially mediated the distance to low fat vegetable relationship. More research is needed to elucidate how environmental variables impact children's dietary intake.

Psychosocial and demographic predictors of fruit, juice and vegetable consumption among 11-14-year-old Boy Scouts.

OBJECTIVE: Psychosocial and demographic correlates of fruit, juice and vegetable (FJV) consumption were investigated to guide how to increase FJV intake. DESIGN: Hierarchical multiple regression analysis of FJV consumption on demographics and psychosocial variables. SETTING: Houston, Texas, USA. SUBJECTS: Boys aged 11-14 years (n = 473). RESULTS: FJV preference and availability were both significant predictors of FJV consumption, controlling for demographics and clustering of Boy Scout troops. Vegetable self-efficacy was associated with vegetable consumption. The interaction of preference by home availability was a significant predictor of FJV. The interaction of self-efficacy by home availability showed a trend towards significantly predicting vegetable consumption. No significant interactions were found between body mass index and the psychosocial variables. CONCLUSIONS: Findings suggest that future interventions emphasising an increase in preference, availability and efficacy may increase consumption of FJV in similar populations.

Fruit and vegetable availability: a micro environmental mediating variable?

OBJECTIVES: To examine the association between fruit and vegetable (F&V) availability and consumption, the possible influences on this association, research gaps, and implications for developing strategies to increase F&V consumption. DESIGN: Systematic review of studies that have examined associations between F&V availability and consumption. RESULTS: Qualitative studies conducted among children and adults indicated that greater availability was associated with greater consumption. This finding was supported by cross-sectional studies among children. Availability was associated with dietary psychosocial variables such as preferences, and it appears that availability may moderate the relationship between these psychosocial variables and consumption. Intervention studies attempting to increase availability have resulted in increased consumption, and availability has predicted change in consumption over an 18-month period. DISCUSSION: Availability appears to be a key proximal determinant of consumption, especially of F&V, and thereby provides a target for change. However, the mechanisms that relate these variables are unclear and there is a need to clarify the direction of causality. We suggest that the possible causal mechanisms may include: (1) availability simply facilitates increased consumption; (2) the visual cues of available food may stimulate consumption; and (3) available food exposure may increase preference, which leads to increased consumption. Each of these possibilities requires close examination, as do policy-level interventions. CONCLUSION: F&V availability is associated with increased consumption. Research that elucidates the mechanisms between availability and intake, and tests policy-level interventions, is needed to advance increased availability as a public health procedure.

Social desirability is associated with some physical activity, psychosocial variables and sedentary behavior but not self-reported physical activity among adolescent males.

This study examined whether controlling for social desirability improved the association between self-reported and objectively measured physical activity among adolescent males and the extent that psychosocial variables predict physical activity after controlling for social desirability. Participants (n=447) were 10- to 14-year old Houston Boy Scouts. Participants completed self-reports of physical activity, sedentary behavior, preferences, self-efficacy and social desirability and wore an MTI accelerometer for 3 days. Correlations were conducted among variables. Regression models were performed to examine the relationships between objectively measured (accelerometer) and self-reported physical activity, objectively measured physical activity and psychosocial variables and self-reports of physical activity and psychosocial variables. All models controlled for social desirability. There were weak associations between self-reported and objectively measured physical activity measures that were slightly improved after controlling for social desirability. Psychosocial variables were strongly associated with self-reports of physical activity, but weakly associated with accelerometer physical activity. Social desirability was positively associated with physical activity preferences (r=0.169) and self-efficacy (r=0.118) and negatively associated (r=-0.158) with self-reported sedentary behavior. Differences in the strength of relationships between self-reported and objectively measured physical activity and psychosocial variables were not a function of social desirability.

Observed, GIS, and self-reported environmental features and adolescent physical activity.

PURPOSE: Examine associations among observed, self-reported, and Geographical Information Systems (GIS) environmental features and physical activity among adolescent males. DESIGN: Cross-sectional study. SETTING: Boy Scout troops and neighborhoods in Houston, Texas. SUBJECTS: Two hundred and ten 10- to 14-year-old Boy Scouts. MEASURES: Accelerometry to obtain minutes of sedentary, light, and moderate to vigorous activity per day. GIS sources were used to identify the numbers of parks, gymnasiums, trails, bus stops, grocery stores, and restaurants within a 1-mile radius of participant residences as well as residential density, connectivity, and crime. Participants provided a self-report of their environment. ANALYSIS: Principal component analysis was used to reduce the number of GIS and self-reported items. Four factors were previously obtained from direct observations of the neighborhoods. Correlations were conducted among factors and physical activity. Regression models were run in which minutes of sedentary behavior, light, or moderate to vigorous physical activity were the dependent variables and environmental factors were the independent variables. Nonsignificant variables were removed in a backward deletion process. RESULTS: Three GIS factors, Parks, Crime, and Gyms, were obtained as were two self-reported factors: difficulty and access and safety. Factor scores were interrelated and associated with the four observed factors. Only observed sidewalk characteristics were correlated with physical activity and were retained in the regression models. CONCLUSION: Environmental factors were interrelated. Only sidewalk characteristics were associated with sedentary behavior and light intensity physical activity.

Fit for Life Boy Scout badge: outcome evaluation of a troop and Internet intervention.

BACKGROUND: This study reports the results of a 9-week intervention on the physical activity levels of adolescent males. METHODS: Participants were 473 10- to 14-year-old Houston Boy Scouts (42 troops) with troops randomly assigned to intervention or control conditions. Data were collected in spring (16 troops) and fall (26 troop) waves during 2003. Intervention participants received a 9-week troop and Internet program to increase physical activity skills, self-efficacy and goal-setting. Physical activity was assessed at baseline, end of the intervention (Post#1) and post-6 months (Post#2) by accelerometer. Minutes of sedentary, light and moderate to vigorous physical activity were calculated. Repeated measure analyses were performed to test differences in physical activity over time between groups with participants nested in troops. RESULTS: A three-way interaction (group * time * wave) that approached significance (P = 0.051) indicated a 12-min reduction in sedentary behavior among spring intervention participants. A significant three-way interaction (P = 0.011) (group * time * wave) indicated a 12-min increase in light intensity activity among the spring intervention group. CONCLUSION: Participation in the Fit for Life badge program resulted in a trend towards a small decrease in sedentary behavior and increased light intensity physical activity among spring participants only. There was no effect on moderate to vigorous physical activity.

Relationships between maternal and child cardiovascular risk factors: ethnic differences and lack of influence of physical activity.

OBJECTIVES: To obtain information about the relationship between cardiovascular and diabetic risk factors of mothers and their children and to determine whether these relationships differ by physical activity or ethnicity. DESIGN: Prospective study. SETTING: The Texas site of the Studies of Child Activity and Nutrition Program. PATIENTS: A 1986 to 1989 triethnic sample (European American, African American, and Hispanic) of 133 mothers and their 6- to 7-year-old children. MAIN OUTCOME MEASURES: Maternal and child fasting insulin levels; total, high-density lipoprotein, and low-density lipoprotein cholesterol levels; triglyceride levels; waist circumference; systolic and diastolic blood pressures; height; weight; and body mass index. Maternal physical activity was assessed by means of a 7-day recall. Child physical activity was assessed by heart rate monitoring. Correlational methods were used to describe the relationships among metabolic risk factors and physical activity; chi2 tests of independence were used to examine the relationships between ethnic groups. RESULTS: Body mass index and waist circumference were significantly (P<.05) associated among Hispanic mothers and their children, but not in other ethnic groups. Insulin, high-density lipoprotein, and low-density lipoprotein levels were significantly associated among African American mothers and their children, but not in other ethnic groups. Maternal and child physical activity were not significantly associated with any of the risk variables or each other. CONCLUSION: The relationships between the risk factors of mothers and children differed by ethnicity, but not by physical activity.

Collaborative planning for formative assessment and cultural appropriateness in the Girls health Enrichment Multi-site Studies (GEMS): a retrospection.

OBJECTIVE: The Girls health Enrichment Multi-site Studies (GEMS), Phase 1, developed and pilot-tested interventions to prevent obesity in African-American preadolescent girls. This article describes the collaborative planning process undertaken to take full advantage of formative assessment activities for improving contextual relevance and cultural appropriateness. DESIGN: Working group activities were designed to stimulate awareness and reflection among group members and, through them, among other field center investigators and staff about developmental, cultural, and contextual issues for formative assessment. SETTING: Telephone, Internet, and face-to-face interactions across GEMS field centers in Houston, Texas; Memphis, Tennessee; Minneapolis, Minnesota; and Palo Alto, California. PARTICIPANTS: Investigators and staff involved in intervention development. MAIN OUTCOME MEASURES: The utility of the process was judged from feedback by participants and field center principal investigators about the contribution of the collaborative effort to improving the perceived relevance and cultural appropriateness of formative assessment data collection and interpretation. RESULTS: A working bibliography was compiled. A detailed matrix of programmatic, child, family, and contextual issues related to ethnicity, socioeconomic status, general health and lifestyle, food, physical activity, and body image/weight control was completed. Additional guidance was derived from a workshop that involved scholars with expertise in aspects of African-American culture, child development, and family processes. CONCLUSIONS: This process improved the breadth and depth of GEMS formative assessment activities by increasing the appreciation of the complex structural, contextual, and personal forces at play. A similar process may be useful to other investigators when attempting to develop culturally appropriate interventions.