Validity and reliability of qualitative dietary fat index questionnaires: a review.
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Adolescent↗
Biomedical subjects
K Resnicow
Publications and source records attributed to K Resnicow.
Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation.
A theory-based multicomponent intervention (Gimme 5) was designed and implemented to impact fourth- and fifth-grade children's fruit, juice, and vegetable (FJV) consumption and related psychosocial variables. Gimme 5 was a randomized controlled intervention trial with school (n = 16 elementary) as unit of random assignment and analysis. Participants included the cohort of students who were in the third grade in the winter of 1994 and students who joined them in the fourth and fifth grades. The intervention included a curriculum, newsletters, videotapes, and point-of-purchase education. Evaluation included 7-day food records and psychosocial measures from students, telephone interviews with parents, and observational assessments. Favorable results were observed for consumption of FJV combined, FJV consumed at weekday lunch, eating FJV self-efficacy, social norms, asking behaviors, and knowledge. A theory-based school nutrition education program can help change children's FJV consumption and impact factors at home that predispose to FJV consumption, but changes were small, and their persistence is unknown.
Child↗
Gimme 5 fruit and vegetables for fun and health: process evaluation.
Gimme 5 (Georgia) was a school-based nutrition education effectiveness trial to help fourth- and fifth-grade students eat more fruit, 100% juice, and vegetables (FJV). Process evaluation assessed fidelity of implementation, reach, and use of intervention materials and environmental mediators: teacher training, curriculum delivery, participation in family activities, attendance at evening point-of-purchase grocery store activities, and availability and accessibility of FJV at home. Approximately half of the curriculum activities were implemented in fourth and fifth grades. The lowest proportion completed were those most pertinent to behavior change. Eighty-seven percent of parents reported participating in homework activities with their fourth grader, 66% with fifth graders. Sixty-five percent of parents reported viewing a video with their child in both grades. Ten percent attended evening point-of-purchase grocery store activities. The low level of implementation and modest level of participation in family activities suggest that higher levels of behavior change may have occurred if exposure to the intervention had been higher.
Adult↗
Reducing the harm of a failed drug control policy.
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Adolescent↗
Smoking status as a vital sign.
OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues. DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1, 366 control subjects) seen by a housestaff physician. INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period. MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.
Adult↗
Influence of school organizational characteristics on the outcomes of a school health promotion program.
Researchers assessed the possible moderating effects of school organizational characteristics (school climate, school health, and job satisfaction) on outcomes of a teacher health behavior change program. Thirty-two public schools were matched and randomly assigned either to treatment or control conditions. Organizational, dietary, and physiologic data were collected from third to fifth grade teachers over three years. Treatment schools received a teacher wellness program for two years. Psychometrics of most organizational scales achieved acceptable levels of reliability. Mixed model analyses were conducted to test for moderating effects. Treatment schools with high organizational climate and health scores reported higher fruit and juice and vegetable consumption at Year 2 compared with intervention schools with low scores. Treatment schools with high job satisfaction scores reported higher fruit and juice and lower-fat food consumption at Year 3 compared with intervention schools with low scores. These measures may be used as a tool to assess the environment in which school health promotion programs are presented. Future interventions may need to be tailored to the organizational characteristics of schools.
Education↗
Cultural sensitivity in public health: defined and demystified.
There is consensus that health promotion programs should be culturally sensitive (CS). Yet, despite the ubiquitous nature of CS within public health research and practice, there has been surprisingly little attention given to defining CS or delineating a framework for developing culturally sensitive programs and practitioners. This paper describes a model for understanding CS from a public health perspective; describes a process for applying this model in the development of health promotion and disease prevention interventions; and highlights research priorities. Cultural sensitivity is defined by two dimensions: surface and deep structures. Surface structure involves matching intervention materials and messages to observable, "superficial" characteristics of a target population. This may involve using people, places, language, music, food, locations, and clothing familiar to, and preferred by, the target audience. Surface structure refers to how well interventions fit within a specific culture. Deep structure involves incorporating the cultural, social, historical, environmental and psychological forces that influence the target health behavior in the proposed target population. Whereas surface structure generally increases the "receptivity" or "acceptance" of messages, deep structure conveys salience. Techniques, borrowed from social marketing and health communication theory, for developing culturally sensitive interventions are described. Research is needed to determine the effectiveness of culturally sensitive programs.
Black or African American↗
2-year tracking of children's fruit and vegetable intake.
OBJECTIVE: To evaluate the tracking of children's fruit and vegetable intake over 2 years. DESIGN: Children in the control group from the Gimme 5 nutrition education intervention trial completed three 7-day food diaries once a year in 1994, 1995, and 1996, beginning when they were in third grade. SUBJECTS: Five hundred sixty-one students from public elementary schools. STATISTICAL ANALYSES PERFORMED: Tracking was examined through correlation of fruit and vegetable servings over the 2 years as well as the percent of subjects remaining in the same or adjacent quintiles of fruit and vegetable intake, using the kappa statistic. RESULTS: Tracking of fruit and vegetable intake was fair to moderate over the 2 years. One-year correlations for total fruit and vegetable servings were .37 for boys and .46 for girls; 2-year correlations were .48 for boys and .40 for girls. kappa values for remaining in the same quintile generally exceeded chance rates only for the top and bottom quintiles. No values exceeded .50. APPLICATION/CONCLUSION: The drift in ranking may have been a result of true changes in fruit and vegetable intake or measurement error (i.e., inability to accurately assess actual intake). If this drift reflects true change, it may be difficult for nutrition education programs targeting this age group to demonstrate long-term behavioral effects on fruit and vegetable intake. If the drift is the result of measurement limitations, improved dietary assessment may yield stronger tracking.
Child↗
How best to measure implementation of school health curricula: a comparison of three measures.
The impact of school health education programs is often attenuated by inadequate teacher implementation. Using data from a school-based nutrition education program delivered in a sample of fifth graders, this study examines the discriminant and predictive validity of three measures of curriculum implementation: class-room observation of fidelity, and two measures of completeness, teacher self-report questionnaire and post-implementation interview. A fourth measure, obtained during teacher observations, that assessed student and teacher interaction and student receptivity to the curriculum (labeled Rapport) was also obtained. Predictive validity was determined by examining the association of implementation measures with three study outcomes; health knowledge, asking behaviors related to fruit and vegetables, and fruit and vegetable intake, assessed by 7-day diary. Of the 37 teachers observed, 21 were observed for two sessions and 16 were observed once. Implementation measures were moderately correlated, an indication of discriminant validity. Predictive validity analyses indicated that the observed fidelity, Rapport and interview measures were significantly correlated with post-test student knowledge. The association between health knowledge and observed fidelity (based on dual observation only), Rapport and interview measures remained significant after adjustment for pre-test knowledge values. None of the implementation variables were significantly associated with student fruit and vegetable intake or asking behaviors controlling for pre-test values. These results indicate that the teacher self-report questionnaire was not a valid measure of implementation completeness in this study. Post-implementation completeness interviews and dual observations of fidelity and Rapport appear to be more valid, and largely independent methods of implementation assessment.
Child↗
Results of the TeachWell worksite wellness program.
OBJECTIVE: This study examined whether providing a school-based teacher wellness program enhances the impact of a health curriculum on student outcomes and improves cognitive, behavioral, and physiological outcomes among participating teachers. METHODS: Thirty-two elementary schools were randomly assigned to experimental or comparison conditions. Comparison group schools received the Gimme-5 program, a curriculum designed to increase fourth and fifty graders' consumption of fruits and vegetables. Experimental schools received Gimme-5 and the teacher wellness program, which included 54 workshops over 2 years, along with several schoolwide health activities. Physiological, behavioral, and cognitive outcomes were assessed in teachers and students. RESULTS: There was no evidence that the intervention favorably modified any student or teacher end points; nor did intervention teachers deliver the Gimme-5 program with greater fidelity than comparison teachers. CONCLUSION: Confidence in the null results is bolstered by the randomized design, baseline sample equivalence, appropriate mixed-model analyses, and lack of selective or differential attrition. Insufficient participation in the wellness program appears a likely explanation for the lack of teacher and student effects. Factors specific to the school setting and intervention may have diminished participation and, thus, intervention effects.
Adult↗
Knowledge about smoking, reasons for smoking, and reasons for wishing to quit in inner-city African Americans.
OBJECTIVE: To determine knowledge about smoking, reasons for smoking, and reasons for wishing to quit and the association of these variables with abstinence at ten weeks and six months. DESIGN: Descriptive study and longitudinal intervention. SETTING: Inner-city public hospital clinics. PARTICIPANTS: 410 African-American cigarette smokers interested in quitting were surveyed at baseline and subsequently enrolled into a double-blind, placebo-controlled, randomized trial of the transdermal nicotine patch. MAIN OUTCOME MEASURES: Descriptive information about smoking knowledge, reasons for smoking, and reasons for wishing to quit, and association of these variables with abstinence at 10 weeks and 6 months. RESULTS: Among the 410 patients randomized, mean age was 48 years, 61% were female, 41% had less than a high school education, 51% had an annual household income less than $8,000, and the average number of cigarettes smoked a day was twenty. The average number of questions answered correctly was nine out of eleven (84%). The most cited reason for smoking was relaxation/tension reduction and the least cited were stimulation and handling of the cigarette. Ninety-nine percent of patients stated they wished to quit for health reasons. Knowledge, reasons for smoking, and reasons for wishing to quit were not significantly associated with 10-week or 6-month abstinence. CONCLUSIONS: In this group of inner-city African-American smokers, knowledge about cigarette smoking was high. Reasons for smoking were related to relaxation, craving, and pleasure, and reasons for wishing to quit were largely health-related. Knowledge, reasons for smoking, and reasons for wishing to quit were not associated with 10 week or 6 month abstinence. Since knowledge about smoking is already high, future efforts should be directed at promoting cessation through proven behavioral and pharmacological approaches, rather than didactic patient education.
Administration, Cutaneous↗
Low validity of a seven-item fruit and vegetable food frequency questionnaire among third-grade students.
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Child↗
Social-cognitive predictors of fruit and vegetable intake in children.
Social-cognitive theory (SCT) was used to explain the fruit and vegetable intake of 1,398 3rd graders. SCT variables assessed included self-efficacy, outcome expectations, preferences, social norms, asking skills, and knowledge. Fruit and vegetable intake was assessed with 7-day records. Bivariate correlations with fruit and vegetable intake ranged from .17 for asking skills to .29 for fruit and vegetable preferences. In analyses controlling for school-level clustering, only preferences and positive outcome expectations remained significantly associated with fruit and vegetable intake, accounting for approximately 10%-11% of the variance. Limitations in the conceptualization, scope, and measurement of the variables assessed may have contributed to the weak associations observed. Models incorporating factors other than individual-level social-cognitive variables may be required to more fully explain children's dietary behavior.
Child↗
Patterns in children's fruit and vegetable consumption by meal and day of the week.
OBJECTIVE: To assess differences in children's consumption of fruit and vegetables (F&V) by day of the week and meal of the day. DESIGN: Baseline data from two school based nutrition education studies were combined for analysis. SUBJECTS/SETTING: 2984 third grade students from 48 participating elementary schools in three school districts in the metropolitan Atlanta area. MEASURES OF OUTCOME: The frequency of consumption of F&V abstracted by trained registered dietitians from prompted 7-day food records. STATISTICAL-ANALYSES PERFORMED: Mixed model analysis with meals and days as terms, controlling for the within school correlation, gender and ethnic group. RESULTS: F&V were most frequently consumed at weekday lunch, and second most frequently at dinner. Participation in school lunch accounted for a substantial proportion of F&Vs consumed at lunch. Few F&Vs were consumed at breakfast or snack. CONCLUSIONS: School lunch makes an important contribution to elementary school students' F&V consumption. Dietary change programs should target parents to increase F&V consumption at dinner, and target students for the meals over which they assert the most control: breakfast and snacks.
Adolescent↗
A self-help smoking cessation program for inner-city African Americans: results from the Harlem Health Connection Project.
The authors develop and test a culturally sensitive, low-intensity smoking cessation intervention for low-socioeconomic African Americans. African American adult smokers were randomly assigned to receive either a multicomponent smoking cessation intervention comprising a printed guide, a video, and a telephone booster call or health education materials not directly addressing tobacco use. The results of the study were mixed. Although no significant effects were observed for the entire treatment cohort, the results of post hoc analyses suggest that culturally sensitive self-help smoking cessation materials plus a single phone contact can produce short-term cessation rates similar to those reported for majority populations. This conclusion should be tempered by the low completion rate for the booster call and several design limitations of the study.
Adolescent↗
Tobacco smoking, cancer and social class.
Consumption of tobacco products, both by smoking and by other means, has long been causally connected with cancers of the lung, larynx, mouth and pharynx, oesophagus, bladder, and many other sites. Tobacco is the main specific contributor to total mortality in many developed countries and has become a major contributor in the developing countries as well. In most industrialized countries, prevalence of cigarette smoking is currently higher in low than in high social classes, although in some industrialized countries smoking was more frequent in high social classes during the first half of this century. The latter pattern of tobacco consumption is more likely to apply to developing countries. To formulate and carry out effective tobacco control activities it is essential to assess the relative incidence of tobacco-related cancers in different social strata and the prevalence of tobacco use across strata. Despite many years of data gathering the information base is far from complete, especially in developing countries where tobacco use is increasing rapidly, and where aggressive marketing by the transnational tobacco industry is occurring. A critical question is the extent to which tobacco usage can 'explain' the observed social class differences in cancer risk. Class differences in lung cancer are likely to be mostly related to the unequal distribution of tobacco smoking between social classes, and in some fairly simple situations this has been satisfactorily demonstrated. Nevertheless, there are many unresolved issues, especially with regard to the role of collateral exposures, such as hazardous occupations, poor diet, and limited access to health care. The question of whether tobacco use 'explains' socioeconomic differences in one or more of the cancers that it causes has rarely been directly addressed in epidemiological studies.
Adolescent↗
The development, reliability, and validity of a risk factor screening survey for urban minority junior high school students.
PURPOSE: To develop and evaluate a risk factor screening survey as a mechanism to identify inner-city junior high school students who may benefit from medical or mental health services available in school-based clinics. METHODS: A 36-item health risk factor screening survey was developed and administered to 3,787 predominantly Hispanic students from four schools in an economically disadvantaged, medically underserved New York City school district. Students who indicated that they were experiencing one of five major risk factors (suicidality, sexual activity, parental or guardian substance use, personal substance use, or having run away) were scheduled to visit the clinic for services, and to have their survey responses validated by clinic interview. RESULTS: The development of the screening tool resulted in a short, easy to read and understand survey instrument that was feasible to administer within a classroom setting. The reliability of the instrument was excellent, and the results of the validity study indicated that it was successful in identifying students who did not need clinic services. The screening tool produced mixed results in identifying those truly in need through single item identification (e.g., produced a moderate number of "false positives"), although combining items on the screening tool produced much higher positive predictive values. CONCLUSIONS: This screening tool can be used to effectively focus limited clinical resources on those in need. Outreach surveys of this type should be considered as a valuable component of a school-based clinic service delivery strategy.
Adolescent↗
Conducting a comprehensive school health program.
Since the late 1980s, the eight-component model of the comprehensive school health program (CSHP), has been adopted widely in the United States and internationally. While it is acknowledged that the eight program elements should be delivered in a coordinated, interactive manner, numerous issues regarding how this integration best can be achieved, including who at the school level should have this responsibility and how the eight components relate conceptually and logistically, have not been addressed adequately. In essence, a CSHP transforms several solo performers into an orchestra. This article proposes the school health coordinator as an essential element in the eight-component model of the CSHP--the maestro, without whom there can be no symphony. The coordinator's principal responsibilities include administration, integration of personnel and programs, evaluation, and direct intervention. Three program elements--staff wellness, healthy environment, and community/family involvement--are subsumed within the coordinator's role, effectively reducing the number of program elements from eight to five. Potential benefits in addition to issues regarding feasibility of the SHC, are discussed and studies examining the effectiveness of the SHC model are recommended.
Administrative Personnel↗