Overweight and Obesity Prevalence and Trends Among Mississippi Public School Students: A Decade of Data Between 2005 and 2015.

This study estimated. the prevalence of overweight and obesity in Mississippi public school students in grades K-12 and examined changes between 2005 and 2015. In 2015, the prevalence of overweight, obesity, and both combined remained higher than national averages, yet the rates have neither increased nor decreased significantly since 2005 (p = 0.6904). In 2015, as with all previous years, there was no difference between boys and girls (p=0.570). As in all previous years, the prevalence of obesity in 2015 was significantly higher among black students (p < 0.001) than among white students. Similar to 2011 and 2013, there was a significant difference by grade level in 2015 (p=0.0029), with the lowest prevalence again among the elementary students. The significant linear decrease in obesity prevalence among elementary school students observed during 2013 continued to 2015 (p = 0.0209). Trends are discussed in the context of state policy and recent research.

Participant adherence indicators predict changes in blood pressure, anthropometric measures, and self-reported physical activity in a lifestyle intervention: HUB city steps.

The objective of this secondary analysis was to evaluate the utility of several participant adherence indicators for predicting changes in clinical, anthropometric, dietary, fitness, and physical activity (PA) outcomes in a lifestyle intervention, HUB City Steps, conducted in a southern, African American cohort in 2010. HUB City Steps was a 6-month, community-engaged, multicomponent, noncontrolled intervention targeting hypertension risk factors. Descriptive indicators were constructed using two participant adherence measures, education session attendance (ESA) and weekly steps/day pedometer diary submission (PDS), separately and in combination. Analyses, based on data from 269 primarily African American adult participants, included bivariate tests of association and multivariable linear regression to determine significant relationships between seven adherence indicators and health outcome changes, including clinical, anthropometric, dietary, fitness, and PA measures. ESA indicators were significantly correlated with four health outcomes: body mass index (BMI), fat mass, low-density lipoprotein (LDL), and PA (-.29 ≤ r ≤ .23, p < .05). PDS indicators were significantly correlated with PA (r = .27, p < .001). Combination ESA/PDS indicators were significantly correlated with five health outcomes: BMI, percentage body fat (%BF), fat mass, LDL, and PA (r = -.26 to .29, p < .05). Results from the multivariate models indicated that the combination ESA/PDS indicators were the most significant predictors of changes for five outcomes--%BF, fat mass, LDL diastolic blood pressure (DBP), and PA--while ESA performed best for BMI only. For DBP, a one-unit increase in the continuous-categorical ESA/PDS indicator resulted in 0.3 mm Hg decrease. Implications for assessing participant adherence in community-based, multicomponent lifestyle intervention research are discussed.

Prevalence and trends in overweight and obesity among Mississippi public school students, 2005-2013.

This study estimated the prevalence of overweight and obesity in Mississippi public school students in grades K-12 and assessed changes in the prevalence between 2005 and 2013. In 2013, Body Mass Index was calculated using measured height and weight data for a weighted representative sample of 4,402 public school students. Additional analyses compared 2013 prevalence estimates by gender, race, and grade levels and for changes between 2005 and 2013. The prevalence of overweight and obesity among public school students no longer appears to be increasing although no significant downward trend was observed (p = 0.0862), and rates remain higher than national averages. In 2013, the combined prevalence of overweight and obesity for all students in grades K-12 was 41.8%, as compared to 40.9% in 2011, 42.4% in 2009, 42.1% in 2007 and 43.9% in 2005. Significant decreases in overweight and obesity were found among white students and elementary school students from 2005 to 2013. White students' combined rates fell from 40.6% in 2005 to 36.8% in 2013 (p = 0.0007). Similarly, combined rates in elementary school students dropped from 43.0% in 2005 to 38.0% in 2013 (p = 0.0002). Additionally, 2013 marked the first year that a significant decline in obesity prevalence was noted among elementary school students, from 25.0% in 2005 to 22.0% in 2013 (p = 0.0163). In 2013, the prevalence of obesity was significantly higher among black students (p < 0.001) and middle school students (p = 0.048). These findings are discussed in light of recent state-wide educational and policy initiatives and on health disparities. Implications for future practice, policy and research are presented.

Improvements in blood pressure among undiagnosed hypertensive participants in a community-based lifestyle intervention, Mississippi, 2010.

INTRODUCTION: Effective strategies are needed to reach and treat people who lack awareness of or have uncontrolled hypertension. We used data from a community-based participatory research initiative, Hub City Steps, to quantify the prevalence of undiagnosed hypertension and determine the relationship between hypertension status at baseline and postintervention improvements in blood pressure and health-related quality of life. METHODS: Hub City Steps was a 6-month preintervention-postintervention lifestyle intervention targeting hypertension risk factors. Outcome measures were collected at baseline, 3 months, and 6 months. Generalized linear mixed models were used to test for effects by time and hypertension status. RESULTS: Of the enrolled sample (N = 269), most were overweight or obese (91%), African American (94%), and women (85%). When considering hypertension status, 42% had self-reported diagnosis of hypertension (self-reported subgroup; 84% with antihypertensive medication use); 36% had no self-reported medical history of hypertension, but when blood pressure was measured they had a clinical diagnosis of prehypertension or hypertension (undiagnosed subgroup); and 22% had no self-reported or clinical hypertension diagnosis (no hypertension subgroup). From baseline to 6 months, systolic blood pressure significantly improved for participants with self-reported hypertension [8.2 (SD, 18.2) mm Hg] and undiagnosed hypertension [12.3 (SD, 16.3) mm Hg], with undiagnosed participants experiencing the greatest improvements (P < .001). Effects remained significant after controlling for covariates. Health-related quality of life significantly improved for all 3 hypertension subgroups, with no apparent subgroup differences. CONCLUSION: This study reveals advantages of a culturally appropriate community-based participatory research initiative to reach those with undetected hypertension and effectively improve blood pressure status and health-related quality of life.

Prevalence and trends in overweight and obesity among Mississippi public school students, 2005-2011.

This study estimated the prevalence of overweight and obesity in Mississippi public school students in grades K - 12 and assessed changes in the prevalence between 2005 and 2011. In 2011, Body Mass Index was calculated using measured height and weight data for a weighted representative sample of 4,235 public school students. Additional analyses compared 2011 prevalence estimates by gender, race, and grade levels and for changes between 2005 and 2011. The prevalence of overweight and obesity among public school students no longer appears to be increasing although a significant downward trend was not observed (p = 0.0845), and rates remain higher than national averages. In 2011, the combined prevalence of overweight and obesity for all students in grades K - 12 was 40.9% as compared to 42.4% in 2009, 42.1% in 2007 and 43.9% in 2005. Significant decreases in overweight and obesity were found among white students and elementary school student groups from 2005 to 2011. White students' combined rates fell from 40.6% in 2005 to 34.8% in 2011 (p = 0.0006). Similarly, combined rates in elementary school students dropped from 43.0% in 2005 to 37.3% in 2011 (p = 0.0045). In 2011, the prevalence of overweight and obesity was significantly lower among white students than black students (p < 0.001) and significantly lower among white female students than black female students at all three grade levels. These findings are discussed in light of recent statewide educational initiatives and health disparities. Implications for future practice, policy, and research are presented.

H.U.B city steps: methods and early findings from a community-based participatory research trial to reduce blood pressure among African Americans.

BACKGROUND: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes. METHODS: The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary self-monitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests. RESULTS: Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p < 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p < 0.001] were significantly reduced. CONCLUSIONS: This CBPR study highlights implementation factors and signifies the community's active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts.

Prevalence and trends in obesity among Mississippi public school students, 2005-2009.

The purpose of this research was to determine the prevalence of overweight and obesity in Mississippi children and youth in grades K-12, and to assess any changes in the prevalence during 2005, 2007, and 2009. Body Mass Index was calculated using measured height and weight data for 3,703 public school students, and the prevalence of overweight and obesity was estimated. Additional analysis compared prevalence estimates by gender, race, and grade for the 2009 data, and comparisons were made between the 2005, 2007, and 2009 data. In 2009, the prevalence of obesity for all students in grades K-12 was 23.9%, as compared to 23.5% in 2007 and 25.5% in 2005. However, no statistically significant differences were found over the three time periods. The disparity between races appears to be increasing over time with the prevalence remaining level for Nonwhite students while dropping each year for White students.

The use and perceptions of concept mapping as a learning tool by dietetic internship students and preceptors.

Critical thinking and problem solving skills are currently emphasis areas in the education of allied health professionals. Use of concept maps to teach these skills have been utilized primarily in nursing and medical education, but little has been published about their use in dietetics education. Therefore the purpose of this study was to evaluate the potential efficacy of concept mapping as a learning tool for nutrition assessment among dietetic interns and its acceptability by internship preceptors. Nineteen dietetic interns and 31 preceptors participated in a quasi-experimental pre-/post-design in which the concept mapping strategy was taught as a replacement for the traditional nutrition care plan. The pre-concept map mean score was significantly lower than the post-concept mean score (28.35 vs. 117.96; p=0.001) based on the Student t-test, thus indicating improved critical thinking skills as evidenced through concept mapping. Overall students' perceptions of concept mapping as a teaching-learning method were more positive than the preceptors' perceptions. In conclusion, internship preceptors and dietetic interns perceived concept mapping as effective in assisting interns to engage in critical thinking, to problem solve, and understand relationships among medical nutrition therapy concepts. However, preceptors had more negative attitudes toward concept mapping than the dietetic interns related to time and effort to complete and evaluate the concept map.

Prevalence of obesity and overweight among children and youth in Mississippi: current trends in weight status.

The purpose of this research was to estimate the 2007 prevalence of obesity and overweight among children and youth and to compare these data with previous prevalence data to determine current trends in weight status in Mississippi. Measured height and weight data were collected on a weighted sample of 3,837 public school students in grades K-12. Prevalence estimates of obesity and overweight, as indicated by Body Mass Index, were calculated. Analyses were made by gender, race, and grade level for 2007 data, and these data were compared to the 2005 findings. In 2007, 23.5% of the students were obese. The prevalence was highest among elementary school students, males and nonwhite students. The prevalence of obesity in 2007 was lower than in 2005, and the decline occurred primarily among middle and high school students. While the 2007 prevalence was still high, the decline suggests that recent obesity initiatives may be having a positive impact.

Prevalence of overweight among elementary and middle school students in Mississippi compared with prevalence data from the Youth Risk Behavior Surveillance System.

INTRODUCTION: The purpose of the Child and Youth Prevalence of Overweight Survey was to estimate the prevalence of overweight and at risk for becoming overweight among children in Mississippi (grades 1-8) using height and weight measures instead of self-report and to compare the findings for grades 6 through 8 with data from the Youth Risk Behavior Surveillance System for middle school students (grades 6-8). METHODS: Students in randomly selected classes from 37 sampled elementary and middle schools throughout Mississippi participated in the study. School staff were trained to collect height and weight data using a standardized procedure. RESULTS: Overall, 24.0% of students in grades 1 through 8 were found to be overweight, and another 14.7% were at risk for becoming overweight. With the exception of sixth grade, there was a trend of increasing prevalence of overweight by grade (17.5% in grade 1 compared with 31.3% in grade 8). In the Child and Youth Prevalence of Overweight Survey, 25.2% of students in grades 6 through 8 were found to be overweight, compared with 18.5% in the Youth Risk Behavior Surveillance System. CONCLUSION: A high percentage of students in Mississippi are already overweight in first grade, and the prevalence tends to increase by grade. Data collected from middle school students through measured heights and weights in the Child and Youth Prevalence of Overweight Survey were higher than self-reported data from the Youth Risk Behavior Surveillance System. Our data suggest that self-reported data underestimate the prevalence of overweight among middle school students. Efforts to monitor students' body mass index and assess effectiveness of interventions should include all grades and use measured heights and weights rather than self-reports.

Nutritional status and food insecurity in hemodialysis patients.

OBJECTIVE: The purpose of this study was to determine whether a relationship exists between nutrition status and food security of patients on hemodialysis (HD). DESIGN: A descriptive correlation study. SETTING: This study consisted of HD patients undergoing treatment at three northeast Louisiana dialysis centers. PATIENTS: Ninety-eight HD patients participated in the study. The mean age of subjects was 59.1 +/- 14.2 years. The sample was 44% white and 56% black; 49% male and 51% female. RESULTS: Multiple linear regression and chi2 analysis were used to assess relationships between demographics and food insecurity scores and Subjective Global Assessment scores. Race significantly predicted food insecurity (beta = 0.248; P = .019), with black patients being more food insecure than white subjects. A significant positive relationship was found between the level of education and Subjective Global Assessment scores (beta = 0.222; P = .037). In this sample, 16.3% of the subjects were found to be food insecure, and 64.3% of the patients were mildly to moderately malnourished, whereas another 13.3% were severely malnourished. CONCLUSIONS: Future research in this area should include food security questions related to the ability to obtain foods for health. Renal health care professionals should assess patients for possible food insecurity so that appropriate interventions can be implemented.

Influences on fruit and vegetable consumption by low-income black American adolescents.

OBJECTIVE: The purpose of this study was to identify personal, behavioral, and environmental factors influencing fruit and vegetable consumption among 10- to 13-year-old low-income black American youth in the lower Mississippi Delta region. Social Cognitive Theory, along with other theoretical constructs, guided focus group questions and analysis. DESIGN: A qualitative study using focus group methodology. SETTING: Enrichment program of a sports summer camp for low-income youth. PARTICIPANTS: Forty-two adolescents (21 female, 21 male) participated in 6 focus groups. MAIN OUTCOME MEASURES: Personal, behavioral, and environmental influences on fruit and vegetable consumption. ANALYSIS: Content analysis methods were used by 3 independent reviewers to identify themes within the focus group transcripts. Themes were summarized and then categorized into the 3 domains of Social Cognitive Theory. RESULTS: The major themes were taste, availability, extended family influence, visual proof of the benefits of fruit and vegetable consumption, and the need for gender-specific behavioral skills. CONCLUSIONS AND IMPLICATIONS: This formative research will aid in the development of a culturally relevant nutrition intervention for low-income black American adolescents in the lower Mississippi Delta region. The results indicate that this group is more likely to respond to interventions that use role models who can provide proof that fruit and vegetable consumption is related to improved health.

Stages of change and fluid intake in dialysis patients.

Nutrition professionals constantly strive to improve adherence to dietary recommendations in hemodialysis patients. The purpose of this study was to evaluate the effects of a 12-week intervention based on stages of change to decrease fluid gain in dialysis patients. Readiness to change, knowledge of appropriate weight gain, and mean weight gains were obtained from patients in five intervention (n=216) and five control (n=100) dialysis units. Intervention had more participants in the maintenance and precontemplation stages at the end of the intervention (P=0.001) compared to the control group. Knowledge scores significantly increased in the intervention group (P<0.001) during the course of the intervention. However, fluid gains did not decrease in either group. Although this intervention did not produce behavior change, the results can aid other educators in planning intervention programs for renal failure and other chronic diseases.

Stages of change in clinical nutrition practice.

For years, nutritionists have developed education materials that attempted to change dietary behaviors. However, most of these programs were effective only in increasing knowledge and did not produce long-term behavior change. Research indicates that nutrition interventions will be more effective if based on a theoretical model. The stages of change theory attempts to explain behavior change as a series of levels of readiness to changes. The stages range from precontemplation, where an individual does not recognize the need for change, to the maintenance of long-term behavior change. Use of this theory in nutrition education has been found to be most effective if education methods are stage specific and address the individual needs of clients. Unfortunately, little research has been done using this theory in traditional clinical nutrition practice, but implementation may be easy for the nutritionist and may help to increase compliance with dietary recommendations in individuals with chronic disease. The first step in using the stages of change theory is to determine the behavior that is going to be changed. With this information, the clinician can then determine the patient's stage of readiness to change a variety of dietary habits. Through the identification of an individual's stage, education methods can be tailored to meet the needs of the patient, helping to promote life-long dietary change.