Comparison of two indices of diet quality with acculturation factors and demographics in Haitian Americans.

This study examined associations of language preference and length of stay in the United States and diet among 132 Haitian Americans aged ≥35, born in Haiti. Two dietary indices, Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI), were used to assess dietary quality. Years in the United States (>15 years; B = 0.063, p = .012) and female gender (B = 5.63, p = .028) were positively associated with AHEI. Lower HEI scores were associated with speaking no English (B = -6.11, p = .026). Participants reporting an income under 20,000/yr had lower AHEI scores (B = -7.63, p = .014). Concurrent use of these indices would provide a screening tool for nutrition intervention. Public health programs targeting low-cost resources, such as community gardening, are recommended to reduce health disparities among this population.

Perceived stress and self-rated health of Haitian and African Americans with and without Type 2 diabetes.

BACKGROUND: Blacks have a higher incidence of diabetes and its related complications. Self-rated health (SRH) and perceived stress indicators are associated with chronic diseases. The aim of this study was to examine the associations between SRH, perceived stress and diabetes status among two Black ethnicities. MATERIALS AND METHODS: The cross-sectional study included 258 Haitian Americans and 249 African Americans with (n = 240) and without type 2 diabetes (n = 267) (n = 507). Recruitment was performed by community outreach. RESULTS: Haitian-Americans were less likely to report 'fair to poor' health as compared to African Americans [OR = 0.58 (95% CI: 0.35, 0.95), P = 0.032]; yet, Haitian Americans had greater perceived stress than African Americans (P = 0.002). Having diabetes was associated with 'fair to poor' SRH [OR = 3.14 (95% CI: 2.09, 4.72), P < 0.001] but not perceived stress (P = 0.072). Haitian-Americans (P = 0.023), females (P = 0.003) and those participants having 'poor or fair' SRH (P < 0.001) were positively associated with perceived stress (Nagelkerke R(2) = 0.151). CONCLUSION: Perceived stress associated with 'poor or fair' SRH suggests that screening for perceived stress should be considered part of routine medical care; albeit, further studies are required to confirm our results. The findings support the need for treatment plans that are patient-centered and culturally relevant and that address psychosocial issues.

Television watching, diet quality, and physical activity and diabetes among three ethnicities in the United States.

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications.

Inadequacy of micronutrients, fat, and fiber consumption in the diets of Haitian-, African- and Cuban-Americans with and without type 2 diabetes.

Micronutrient insufficiency, low dietary fiber, and high saturated fat intake have been associated with chronic diseases. Micronutrient insufficiencies may exacerbate poor health outcomes for persons with type 2 diabetes and minority status. We examined dietary intakes using the Recommended Dietary Allowances (RDAs) of micronutrients, and Adequate Intakes (AIs) of fiber, and Dietary Guidelines for Americans (DGA) for saturated fat in Haitian-, African-, and Cuban- Americans (n = 868), approximately half of each group with type 2 diabetes. Insufficient intakes of vitamins D and E and calcium were found in over 40 % of the participants. Over 50 % of African- and Cuban- Americans consumed over 10 % of calories from saturated fat. Haitian-Americans were more likely to have insufficiencies in iron, B-vitamins, and vitamins D and E, and less likely to have inadequate intake of saturated fat as compared to Cuban-Americans. Vitamin D insufficiency was more likely for Haitian-Americans as compared to African- Americans. Diabetes status alone did not predict micronutrient insufficiencies; however, Haitian-Americans with no diabetes were more likely to be insufficient in calcium. Adjusting for age, gender, energy, smoking, physical activity, access to health care, and education negated the majority of micronutrient insufficiency differences by ethnicity. These findings suggest that policies are needed to ensure that low-cost, quality produce can be accessed regardless of neighborhood and socioeconomic status.

Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults.

OBJECTIVE: To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN: Randomized repeated measures experimental design. SETTING: Churches and community-based organizations. PARTICIPANTS: Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION: Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1's program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES: Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS: Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS: Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS: A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues.

OBJECTIVE: To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. METHODS: Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses. RESULTS: Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04). CONCLUSIONS AND IMPLICATIONS: Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education.

Diarrheal illness among women, infants, and children (WIC) program participants in Miami, Florida: implications for nutrition education.

OBJECTIVE: To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Miami, FL. DESIGN: A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness. SETTING: WIC clinic operated by the Miami-Dade County Health Department in Florida. WIC is a national program for nutritionally at-risk, low-income young children and pregnant or postpartum women. PARTICIPANTS: WIC female clients at least 18 years of age who are able to read and speak English (n = 299). MAIN OUTCOME MEASURE: Diarrheal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days. ANALYSIS: Univariate and multiple logistic regression analyses. RESULTS: Food safety behaviors significantly associated with diarrheal illness included not washing hands before preparing meals (P = .048) and baby bottles (P = .045) or after changing diapers (P = .009) and not washing all items that touched raw meat before preparing the next food item (P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women (P = .002). CONCLUSIONS AND IMPLICATIONS: These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIC clients, particularly pregnant women.

A cognitive-behavioral weight control program improves eating and smoking behaviors in weight-concerned female smokers.

Many people use smoking as a weight control mechanism and are averse to quitting for fear of weight gain. These weight-concerned smokers tend to be women, are significantly less likely to stop smoking or to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman's motivation to quit smoking correlates positively with her confidence in her ability to control her weight after quitting. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. This randomized controlled trial investigated the effects of a weight control program on eating and smoking behaviors in a group of female, weight-concerned smokers from July 2005 to June 2006. Two hundred sixteen subjects who wanted to lose weight but were not yet ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of 12 1-hour sessions. Subjects were randomly assigned to either the weight-control program (intervention group) or the control group. Differences between the intervention and control groups were evaluated using t tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and chi(2) tests for categorical variables. The intervention group had a 14% increase (P<0.001) in self-efficacy for weight control (Weight Efficacy Life-Style Questionnaire), which was associated with improved diet quality (Healthy Eating Index) (r=0.292, P<0.01), weight loss (r=0.582, P<0.001), increased self-efficacy for quitting smoking (Smoking Self-Efficacy Questionnaire) (r=0.291, P<0.014), a decrease in number of cigarettes smoked (r=0.331, P<0.005), and positive movement in stage of change toward smoking cessation (r=0.435, P<0.001). These findings suggest that for this group of weight-concerned smokers' success in changing eating behavior may trigger a positive change in smoking behavior.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children.

BACKGROUND: Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. OBJECTIVE: To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. DESIGN: A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. SUBJECTS/SETTING: Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. INTERVENTION: Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. MAIN OUTCOME MEASURES: Change from pre- to postintervention food safety scores. STATISTICAL ANALYSES PERFORMED: A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. RESULTS: Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. CONCLUSIONS: The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Food safety practices among pregnant women and mothers in the women, infants, and children program, Miami, Florida.

Pregnant women and infants are two groups at the highest risk of severe outcomes from foodborne illnesses. We surveyed adult clients of a Women, Infants, and Children (WIC) clinic serving predominately African Americans in inner-city Miami, Florida, to assess food safety practices. Eligible and consenting women completed a 23-item self-administered survey with questions concerning food handling practices around the Partnership for Food Safety Education's Fight BAC! campaign constructs of "clean", "separate" (not cross-contaminated), "cook", and "chill". Of 342 eligible clients, 299 (87.4%) consented to participate. In general, the clients' food safety practices were most problematic in the cook and chill constructs. Using a cooking thermometer, refrigerating foods within 2 h, and thawing them safely were the least commonly reported safe practices. Women who were pregnant with their first child had the lowest food safety practice scores. Of the 62 pregnant participants, 32 (51.6%) reported eating hot dogs or deli meats without first reheating them some of the time or more often, and 22 (35.5%) reported eating soft cheeses and blue-veined cheeses some of the time or more often, putting the women at risk of listeriosis. Although all women in the WIC program could benefit from food safety education, these findings indicate that women during their first pregnancy should especially be targeted for food safety education.

Food safety beliefs and barriers to safe food handling among WIC program clients, Miami, Florida.

OBJECTIVE: To determine beliefs about and barriers to good food safety practices among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). DESIGN: Five audiotaped focus groups. SETTING: A large WIC Program clinic in Miami, Florida. PARTICIPANTS: Thirty-two women attending the clinic who were demographically similar to clinic clients. PHENOMENON OF INTEREST: Beliefs about, barriers to, and motivators for good food safety practices. ANALYSIS: Focus groups were audiotaped and transcribed. Transcripts were independently analyzed by three researchers to identify recurring ideas within and between groups. RESULTS: Participants did not perceive foodborne illnesses as a major problem or believe that foodborne illnesses usually resulted from poor food handling practices at home. The hardest practice to follow was using a cooking thermometer. Leaving perishable foods and baby bottles outside the refrigerator for longer than 2 hours were additional problems reported. Participants reported that their babies' health was the most important motivator to good food safety practices and that women may be most receptive to food safety education during their first pregnancy. CONCLUSIONS AND IMPLICATIONS: WIC clients in this clinic have several deficiencies in their food safety knowledge and practices. The WIC Program may be well positioned to help its clients, particularly pregnant women, improve food safety practices.