Awareness and accuracy of height and weight among mothers and their preschool-aged children.

OBJECTIVES: A constant challenge in addressing the issue of obesity is the validity and reliability of self-reported measurements to calculate body mass index, that assesses the prevalence of obesity in a population. The objective of this study is to analyze both awareness and accuracy of mothers who are overweight or obese, in reporting their own and their child's height and weight measurements. STUDY DESIGN: cross-sectional study. METHODS: In this study, mothers were asked over phone to self-report height and weight for them and their child. This was followed by objective measurement of maternal and child height and weight by study staff in a clinical setting. The descriptive and statistical analysis of the data obtained were carried out using SAS software. RESULTS: 1) The mean weight of mothers who inaccurately self-reported their weight was 9.5 kg greater than the mean weight of those who reported accurately (P < 0.001). (2) Despite being aware of, and reporting their own measurements, 50% (n = 116) of mothers reported not knowing their child's height and 23% (n = 54) of them reported not knowing their child's weight. CONCLUSION: Strategies to tackle both maternal awareness and accuracy of child's measurements can help with early identification of child's obesity risk and prevention of long-term consequences.

Multilevel correlates of household anthropometric typologies in Colombian mothers and their infants.

BACKGROUND: The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data. METHODS: Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained. RESULTS: This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology. CONCLUSION: Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.

Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals.

OBJECTIVES: The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN: Cross-sectional group comparison. METHODS: Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS: Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS: EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.

Associations between feeding practices and maternal and child weight among mothers who do and do not correctly identify their child's weight status.

OBJECTIVE: This study aimed to explore factors associated with accuracy of maternal weight perception and determine if maternal feeding practices are associated with weight status. METHODS: Overweight/obese mothers reported demographics and perception of their child's weight and completed a modified preschooler feeding questionnaire. Mother's and child's height and weight were measured. Logistic regression was used to explore associations between demographic factors and accuracy. Correlations between the preschooler feeding questionnaire scales and mom's body mass index (BMI) and child's BMI-percentile were explored for the total sample and accurate and underestimating moms. RESULTS: Among mothers whose child was overweight or obese, only 20% of mothers correctly identified the child as overweight. Forty percent of moms were underestimaters. There was a positive correlation between concern the child was overweight/overeating and the child's BMI-percentile among underestimating moms; in the total sample (r = 0.32, p < .001) and accurate moms (r = 0.52, p < .001). In underestimaters only, there was a negative relationship between child BMI-percentile and pressure to eat (r = -0.30, p < .001) and concern about child underweight (r = -0.47, p < .001). CONCLUSIONS: This study identified different associations between child weight and mother's feeding practices in mothers accurately and inaccurately perceiving her child's weight. Intervention studies should explore targeting education on feeding practices based on these perceptions.

Introduction to the special issue on achieving healthy weight in black American communities.

The prevalence of obesity is high in the United States, and highest among racial and ethnic minority groups. This special issue of Obesity Reviews is based upon evidence reviews prepared for and presented at a national invited workshop convened by the African American Collaborative Obesity Research Network (AACORN) in August of 2012. A set of potential topics was developed, a priori, and AACORN network members and colleagues with relevant expertise were invited to lead evidence reviews. The result is 10 articles focused on providing a comprehensive picture of what is known and unknown about interventions to prevent and treat obesity or improve weight-related behaviours in African American adults and children. Evidence reviews included in this special issue focus on children and adolescents (n=2); adults from various perspectives (n=5); eHealth interventions (n=1); interventions within faith organizations (n=1); and environmental and policy change interventions (n=1). Overall, the reviews show a small evidence base for research on African Americans and call for additional prioritization of funding to include studies that can inform action and bring progress in obesity prevention and treatment in African Americans on par with the scope and seriousness of the problem.

What works for obesity prevention and treatment in black Americans? Research directions.

Obesity prevalence in black/African American children and adults of both sexes is high overall and compared with US whites. What we know, and do not know, about how to enhance the effectiveness of obesity prevention and treatment interventions in African Americans is the focus of the 10 articles in this special issue of Obesity Reviews. The evidence base is limited in quantity and quality and insufficient to provide clear guidance. With respect to children, there is relatively consistent, but not definitive support for prioritizing the systematic implementation and evaluation of child-focused interventions in pre-school and school settings and outside of school time. For adults or all ages, developing and refining e-health approaches and faith-based or other culturally and contextually relevant approaches, including translation of the Diabetes Prevention Program intervention to community settings is indicated. Major evidence gaps were identified with respect to interventions with black men and boys, ways to increase participation and retention of black adults in lifestyle behaviour change programmes, and studies of the impact of environmental and policy changes on eating and physical activity in black communities. Bold steps related to research funding priorities, research infrastructure and methodological guidelines are recommended to improve the quantity and quality of research in this domain.

The relationship between parental modeling, eating patterns, and dietary intake among African-American parents.

OBJECTIVE: This article examines the relationship between the frequency with which African-American parents report modeling healthful dietary behaviors for their children and parental dietary intake. DESIGN: Cross-sectional, baseline data from a community-based dietary change study to reduce fat intake and increase fruit and vegetable consumption among African-American parents was analyzed to identify role-modeling behaviors. SUBJECTS/SETTING: Subjects were 456 African-American parents who participated in a dietary change study as part of a national parent education group. Participants completed the Parental Dietary Modeling Scale, an eating patterns questionnaire and a food frequency questionnaire. STATISTICAL ANALYSES PERFORMED: Descriptive statistics and stepwise multiple linear regression analyses were conducted. RESULTS: Parental modeling of healthful dietary behavior was associated with the performance low-fat eating patterns (r = 0.48; P < .001), lower dietary fat intake (r = -0.30; P < .001), and higher consumption of fruits and vegetables (r = 0.18; P < .001). APPLICATIONS: The frequency with which parents model healthful dietary behaviors may be associated with parental dietary intake and may have long-term implications for the development of childhood eating patterns. Dietetics professionals need to carefully assess parents' current dietary modeling behaviors and inform parents about how performance of these general behaviors may affect their child's ultimate nutrition health.

A community research partnership to improve the diet of African Americans.

OBJECTIVE: To describe a community research partnership in which a national parent education organization collaborated with academic institutions to develop a dietary change program for underserved African American parents. METHODS: Qualitative methods were used to characterize issues that impacted partnership operations. RESULTS: Data are reported on partnership activities including program development and implementation with African American parents. Lessons learned and strategies for improving the partnership are presented. CONCLUSIONS: Ongoing assessment and evaluation of how a partnership operates, especially in the context of multiple sites, are important to sustaining successful functioning.

Smoking and diabetes.

The objective of this review is to summarize the literature on diabetes and smoking related to epidemiological risks, efficacy and cost-effectiveness of different cessation approaches, and implications for clinical practice. Over 200 studies were reviewed, with special emphasis placed on publications within the past 10 years. Intervention studies that included patients with diabetes but did not report results separately by disease are included. Diabetes-specific studies are highlighted. There are consistent results from both cross-sectional and prospective studies showing enhanced risk for micro- and macrovascular disease, as well as premature mortality from the combination of smoking and diabetes. The general cessation literature is extensive, generally well-designed, and encouraging regarding the impact of cost-effective practical office-based interventions. In particular, system-based approaches that make smoking a routine part of office contacts and provide multiple prompts, advice, assistance, and follow-up support are effective. Although there is minimal information on the effectiveness of cessation interventions specifically for people with diabetes, there is no reason to assume that cessation intervention would be more or less effective in this population. There is a clear need to increase the frequency of smoking cessation advice and counseling for patients with diabetes given the strong and consistent data on smoking prevalence; combined risks of smoking and diabetes for morbidity, mortality, and several complications; and the proven efficacy and cost-effectiveness of cessation strategies.

Staging of dietary patterns among African American women.

This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p<.05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p<.05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.

A comparison of the overall NRMP match results with the results for 19 specialties for senior U.S. medical students, 1996.

PURPOSE: To compare U.S. medical student Match results in 1996 for 19 categorical residency positions by specialty with those of the overall Match reported by the National Resident Matching Program (NRMP). METHOD: Data for the numbers of "active" senior U.S. student applicants (those who submitted rank lists), the numbers of U.S. seniors matched, and the numbers of unfilled positions for 19 specialties were obtained from a variety of sources. Chi-square analysis was performed to compare Match results for each independent specialty with the overall Match results. The level for statistical significant was set at p < .005. RESULTS: Eight specialties were identified as significantly more competitive than the overall Match process for both the percentage of U.S. seniors who successfully matched in that specialty and the ratio of unmatched U.S. senior applicants to unfilled categorical positions. Five specialties were identified as significantly less competitive for these two measures. Six specialties showed no significant difference in the percentages of U.S. students matching, but for three of these specialties there were more unmatched students than unfilled categorical positions. CONCLUSION: U.S. medical student Match results for categorical residency positions for different specialties vary significantly from the overall Match process. This information can be used in counseling senior medical students on their specialty selection and the residency application process.

Articulation of asthma and its care among low-income emergency care recipients.

Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system.

The feasibility of recruiting hospitalized patients with diabetes for a smoking cessation program.

The aims of this study were to identify hospitalized smokers with diabetes, assess the severity of their physical condition, and determine their willingness to participate in a postdischarge smoking cessation program. Hospitalized smokers with diabetes were identified through referrals from the Dietetics Department. Smoking status was determined via medical charts, healthcare staff, and patient self-report. Among all patients with diabetes who were identified (n = 314), smoking status was routinely recorded only for those with a primary cardiac diagnosis (41%). Smokers (n = 59) were significantly younger and reported multiple but fewer concomitant diagnoses than nonsmokers. Ninety-one percent of the smokers who were contacted refused to participate in a postdischarge smoking cessation program. We conclude that accurate methods are needed for identifying all smokers to facilitate cessation efforts. The severity and chronicity of the physical condition of hospitalized smokers with diabetes may limit willingness to participate in a postdischarge smoking cessation intervention.

Beliefs about smoking and diabetes care.

The purpose of this study was to address the following questions: 1) Do smokers with diabetes believe that cigarettes have favorable outcomes associated with diabetes management? 2) Do smokers with diabetes believe that quitting smoking negatively impacts diabetes management? 3) Do smokers with diabetes perceive significant others as being supportive of attempts to quit smoking? and 4) What is the relationship between these factors and attitude toward quitting smoking? Patients with insulin-dependent diabetes mellitus (IDDM) completed a measure of Attitude Toward Quitting Smoking, which assessed desire and confidence in ability to achieve cessation, and the Diabetes and Smoking Beliefs Questionnaire, which assessed beliefs regarding cigarettes and diabetes management. Smokers whose attitudes reflected less desire to quit and less confidence in doing so reported that cigarettes had utility in diabetes management, that quitting has negative effects on diabetes, and perceived significant others as only moderately supportive of attempts to quit smoking. Implications of these findings for diabetes education are discussed.

Depressive symptomatology and smoking among persons with diabetes.

The purpose of this study was to determine whether (a) symptoms of depression are more prevalent and severe among diabetic smokers than diabetic nonsmokers, (b) smoking is related to depressive symptomatology among diabetic patients, and (c) there is a positive relationship between number of cigarettes smoked and severity of depressive symptoms. Diabetic non-smokers (n = 103) and diabetic smokers (n = 83) were surveyed regarding symptoms of depression as measured by the Beck Depression Inventory (BDI). Depressive symptomatology was more prevalent and severe among smokers than nonsmokers. Smoking was significantly associated with depressive symptomatology. Among smokers, the number of cigarettes smoked per day was independently associated with cognitive symptoms of depression.

Interactive use of models of health-related behavior to promote interdisciplinary collaboration.

This pilot study examined the use of models of health-related behavior as foci for interaction to promote interdisciplinary collaboration among students enrolled in a graduate-level course at Washington University in St. Louis, Missouri. The course is one component of a master's program developed to meet the needs of health professionals whose goals are to participate in interdisciplinary roles in a variety of health care settings. Abilities requisite to the development of positive attitudes toward interdisciplinary collaboration include: (1) understanding of the functional roles of each discipline within the team; and (2) respect and value for each discipline's input in the decision-making process of the health team. Focused interaction was effective in increasing participants' understanding of the functional roles of each discipline at the .05 level of significance.

A comparison of patient attitudes toward asthma self-management among acute and preventive care settings.

This study characterizes the attitudes regarding asthma and asthma care of low-income, African-American adults who receive care from acute care settings. As a point of reference, their attitudes and knowledge were compared with those of a group of patients receiving asthma care from a private setting that stresses preventive asthma self-management. Patients were assessed regarding attitudes toward (1) routine asthma self-care and decisions as to when to self-treat versus seek asthma care, (2) administration of asthma medications, (3) satisfaction with acute-care services, and (4) the desire for asthma education. Asthma morbidity, sociodemographic characteristics, awareness of environmental triggers, and daily stressors were also assessed. Responses of adults receiving most of their asthma care from acute care settings suggest the same pattern of failure to treat asthma regularly and delay in seeking care as implicated in asthma deaths among children. Emphasis on self-treatment of asthma symptoms, not preventive self-management, was apparent among the attitudes of the acute care patients. Lack of regular care, delay of treatment, and reliance on self-treatment via over-the-counter medications was noted. Implications of these findings for the development of asthma education programs are addressed.

Methods, successes, and failures of smoking cessation programs.

Addictive and conditioning processes interact to make cigarette smoking a common, lethal behavior that is highly resistant to change. In addition to addiction and conditioning, smoking is maintained by a wide range of forces, ranging from social modeling and advertising to the politics and economics of international trade. Parallel to this wide range of causes of smoking, interventions to encourage smoking cessation range from simple information and suggestions to smoking cessation classes, to nicotine replacement, to community or national campaigns that promote nonsmoking. Clinicians can make contributions throughout this range of activities, from the consulting room to political advocacy. While no one of these is highly successful on its own, together they have prompted almost 50% of smokers to quit, an impressive accomplishment.

Community organization to reduce the risk of non-insulin-dependent diabetes among low-income African-American women.

Non-insulin-dependent diabetes mellitus is epidemic among African-American women in the United States; reports of its prevalence among African Americans range from 50% to 60% higher than among whites. African Americans also incur higher rates of diabetes-related complications such as blindness, end-stage renal disease, and amputations. Data indicate that non-insulin-dependent diabetes among African Americans is associated with lower socioeconomic status and with obesity. Because obesity has been hypothesized as contributing to the growing numbers of non-insulin-dependent diabetics among African-American women, new strategies are urgently needed to promote weight loss in this population. Community organization can broaden health education and facilitate behavior change toward development of life- and self-mastery skills. Specific strategies of this approach include (1) integrating community values into health messages, (2) facilitating neighborhood "ownership" and decision-making, (3) utilizing existing formal and informal networks, and (4) empowering individuals and community. Community organization may be a promising strategy among low-income minority communities to reduce the risk of non-insulin-dependent diabetes by promoting changes in dietary patterns, because it ensures that the health messages and programs that emerge will be consistent with existing sociocultural norms and beliefs.