The relationship of body size to participation and success in a fruits and vegetables intervention among low-income women.

We examined participation and dietary change among women participants in a community-based nutrition education program, to determine whether intervention results differed by participant body size. Four dietary indicators (daily servings of fruits and vegetables, total calories, calories from fat, and Healthy Eating Index score) were assessed from 24-h recalls taken before, immediately after, and 4 months after a seven-session nutritional education program, from 156 African-American women age 20-50, in Washington, D.C. public housing. Knowledge, attitudes and practices related to nutritional behavior change were collected at three time points as well. Random effect models were used to examine dietary patterns, and compare change by body size and class attendance. Results showed that obese women (BMI > or = 30) had more psychosocial barriers to dietary change and poorer baseline diets, but stronger program attendance. Post-intervention, both groups consumed approximately 250 fewer calories and 2.5% fewer calories from fat. At follow-up, non-obese women consumed significantly fewer calories; obese women consumed significantly fewer calories from fat, and showed significant improvement in HEI. Given the prevalence of obesity in low resource communities, nutritional interventions should tailor strategies to participant body size and related psychosocial needs.

Evaluation of a nutrition education intervention for women residents of Washington, DC, public housing communities.

We designed, implemented and evaluated an educational intervention to increase fruit and vegetable consumption among urban African-American women. Women aged 20-50 years (n=212) from 11 public housing communities participated in seven 90-min classes with a professional nutritionist. Our prospective pre- and post-test design, with 4-month follow-up, assessed the relationship between attendance and dietary change, using three 24-hour recalls per time point. Mean change in average daily dietary values for fruits and vegetables, calories and percent calories from fat (post-test versus pre-test, follow-up versus pre-test) was compared by class attendance, to evaluate the impact of class attendance on dietary change. Attendance varied from zero (35%) to five to seven classes (42%). Baseline dietary recalls showed average daily consumption of 3.05 servings of fruits and vegetables, 2416 calories and 35.8% calories from fat. No improvements in fruit and vegetable consumption, but statistically significant decreases in total calories and percent calories from fat, were seen at both endpoints. Women attending five to seven classes had the greatest dietary improvements, averaging, at post-test and follow-up, respectively, 246.2 and 324.5 fewer calories and 3.08 and 2.97% fewer calories from fat. Results suggest that, for some residents of low-resource communities, small group interventions are popular, effective vehicles for nutrition education.

A problem solving approach to nutrition education and counseling.

This report applies problem-solving principles to the design and implementation of nutrition education and counseling programs. A framework is proposed that builds on an extensive body of research in mental health and health education that has demonstrated the efficacy of a problem-solving approach to helping people cope with stressful life events. Our framework uses problem-solving principles in helping participants in nutrition education or counseling programs to overcome obstacles they experience in changing their nutrition behaviors. Both research and clinical experience suggest that incorporating problem-solving techniques in nutrition education and counseling will increase long term change in nutrition behaviors.

Predictors of adherence to screening mammography among Korean American women.

BACKGROUND: Breast cancer is the most commonly diagnosed cancer among Korean American women (KAW). Many KAW are not aware of the importance of regular screening. This research estimates the rates of regular breast cancer screening and examines the predictors and barriers to obtaining regular mammograms. METHODS: Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing. RESULTS: About 33% had regular mammograms. In multiple logistic regression analyses, the strongest correlate of regular mammograms was knowledge of screening guidelines. Age, spoken English proficiency, and physician recommendations were associated with regular mammograms. Employment interacted with insurance: Employed women without insurance had lower rates of mammograms than those employed with insurance. The most frequent reason for not having regular mammograms was a woman's belief that she was at low risk for breast cancer. CONCLUSIONS: Results indicate that knowledge of screening guidelines and physician recommendations for screening are important in this minority population. Culturally relevant educational programs about breast cancer screening should be developed for less acculturated women and recent immigrants.

Perceived access to health care and its influence on the prevalence of behavioral risks among urban African Americans.

INTRODUCTION: Individuals who have difficulty gaining access to health care may delay seeking and obtaining treatment, underutilize preventive health care services, and may have a high prevalence of chronic disease risks. This report examines participant perception of the level of difficulty encountered when obtaining medical care and its influence on the prevalence of chronic disease behavioral risks among urban African Americans. RESULTS: We found a significantly higher prevalence of current cigarette smoking and alcohol consumption among African Americans who reported that they experienced difficulty in obtaining medical care than among those who did not. Compared to those who experienced no difficulty obtaining care, participants who perceived a high level of difficulty in obtaining care were less likely to have had a physical exam in the past year and to have seen the same doctor when services were obtained. CONCLUSION: The perception of a high level of difficulty obtaining health care may be associated with a higher prevalence of behavioral risks for chronic disease. The limited data suggest a need to more closely examine the perception of health care accessibility and its relationship to health services utilization and the prevalence of chronic disease behavioral risks.

Trend in the prevalence of overweight and obesity among urban African American hospital employees and public housing residents.

INTRODUCTION: To help understand the impact of socioeconomic status, we examined the current prevalence and age-specific trend in overweight and obesity among two socioeconomically diverse groups of African Americans in the Washington, DC, area. MATERIALS AND METHODS: Data on height and weight were collected between March 1995 and December 1996 as a part of nutrition survey to develop a food frequency questionnaire. Gender-stratified multiple logistic regression analyses were used to examine factors related to the current prevalence of overweight and obesity. RESULTS: Three hundred nine African American public housing residents and 293 African American hospital employees participated in this survey. Overall, hospital workers and public housing residents differed significantly in the distribution of BMI (p = 0.003). Among men, the prevalence of overweight and obesity were 34.9% and 29.4% for hospital workers and 27.0% and 18.2% for public housing residents, respectively. For females these rates were 31.3% and 46.3% for hospital employees and 26.1% and 42.9% for public housing residents, respectively. CONCLUSION: Overweight and obesity were highly prevalent among all age and socioeconomic groups. Future research should focus on a more in-depth study of the relationship between socioeconomic status and the correlates of obesity among African-Americans, particularly women.

Perceptions of cancer in an African-American community: a focus group report.

OBJECTIVES: To assess cancer perceptions, beliefs, and barriers to prevention among African-American residents of West Baltimore for the purpose of informing community cancer control initiatives. DESIGN AND METHODS: We conducted focus group interviews with local healthcare providers and African-American Baltimore City residents. Focus group interviews were read and analyzed using qualitative analytic techniques, emphasizing themes and patterns in responses. RESULTS: The community member and local healthcare provider focus groups identified strikingly similar themes. In particular, participants in both groups discussed the pervasive fear and stigma associated with cancer within the African-American community. Both groups identified cancer fatalism, misperceptions of the nature of cancer and its treatment, competing priorities, and a 'crisis orientation' toward medical care as key barriers to prevention and early diagnosis. Participants in all focus groups were also acutely concerned about community distrust of the healthcare system. CONCLUSIONS: The principal themes identified in this hypothesis-generating study were potentially modifiable factors, giving rise to optimism that interventions informed by these results could have a substantial impact on cancer control in this community.