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PubMed2004

Contrasting mediating variables in two 5-a-day nutrition intervention programs.

BACKGROUND: Researchers have advocated mediational analysis for behavioral intervention studies to link the supporting theory used in an intervention with the mediating variables and with its ultimate success or failure. Few mediational analyses have been reported for school-based nutrition studies. The conduct of mediational analyses within multi-site studies may provide advantages for the standardization of methods and for the replication and generalizability of findings. METHODS: This study identified mediators of two school-based nutrition interventions for 4th graders. Three variables were tested on the four criteria necessary to establish mediation of intervention effects on changes in fruit and vegetable consumption (FVC) in 4th graders (Alabama, N = 1584; Minnesota, N = 522). FVC was measured in children using 24-h dietary recalls. Mediators were assessed using questionnaires completed by children and parents. RESULTS: All criteria were met in Alabama for a single-item measure of knowledge of the 5-a-day daily consumption guideline. Knowledge and parent consumption satisfied one criterion in Minnesota. Knowledge accounted for 9.78% of the total intervention effect in Alabama. CONCLUSIONS: Knowledge of the 5-a-day guideline for fruit and vegetable consumption may mediate intervention effects. Future work should include tests of mediational models in multi-site studies.

Alabama↗
PubMed1998

Profile of public health nutrition personnel: challenges for population/system-focused roles and state-level monitoring.

OBJECTIVE: Our 3 objectives were to document the current public health nutrition workforce in the United States, identify top public health nutrition priorities for the next 5 years, and assess the capacity of public health nutrition personnel to address these priorities and the nutrition-related objectives of Healthy People 2000. DESIGN: A census survey was distributed to public health nutrition personnel in all state and local health agencies and nonprofit and for-profit agencies funded by official health agencies throughout the United States and US territories. Also, state and territorial nutrition directors were sent a different questionnaire. SUBJECTS: Data were collected from 49 states, the District of Columbia, and 2 territories; 7,550 public health nutrition personnel were represented. STATISTICAL ANALYSIS: Data were analyzed using EpiInfo software. Descriptive statistics are presented. RESULTS: Almost half of the respondents worked in local or county health agencies and about two thirds were involved in direct care services. Only about 40% were registered dietitians and about one fourth had a master's degree. Almost 90% of all full-time equivalent positions were funded through federal dollars; 78% of all funding was from the Special Supplemental Nutrition Program for Women, Infants, and Children. Top health concerns identified were diet/nutrition to prevent chronic disease, low breast-feeding rates, low birth weight, iron deficiency anemia, and obesity/overweight. Public health nutrition personnel will be challenged to assume population/system-focused roles and state-level monitoring of Healthy People 2000 objectives. Only 2 of the 17 nutrition objectives of Healthy People 2000 were monitored by more than 50% of the states. APPLICATIONS: If official health agencies are to shift to public health core functions, as recommended by an Institute of Medicine report, then a substantial proportion of the public health nutrition workforce must not only change how they practice but also obtain the knowledge and skills to do so. Strategies to improve workforce capacity are discussed, including continuing education interventions through professional organizations, distance and on-campus educational opportunities through approved public health nutrition programs, and advocacy for new funding streams focused on public health core functions.

Dietetics↗
PubMed2002

Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults.

BACKGROUND: Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors. METHODS: One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken. RESULTS: Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high. CONCLUSIONS: Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.

Adult↗
PubMed1987

Effect of lighting program and nutrition on feather replacement of molted single comb White Leghorn hens.

This experiment concerned the induced molt of 320 60-wk old Single Comb White Leghorn hens placed two per cage in two adjoining sections of a light-tight, fan-ventilated poultry building. Treatments compared were: 1) lighting program: Washington (WSU) vs. North Carolina (NCSU). The WSU program used 8 h light/day for 28 days beginning 7 days before fast. The NCSU program used continuous light for 7 days prior to fast, followed by 12 h light/day for 21 days. The light portion of the photoperiod was then increased in steps in both treatments to 16 h. 2) Molt diet: cracked corn (CC) vs. 16% protein molt ration (MR) for 14 days. 3) Laying diet. A 14% protein mash calculated to contain .60% or .65% total sulfur amino acids (TSAA) or ascorbic acid (AA) at 0 or 50 ppm added to the laying mash. Day 1 was designated as the first day of photoperiod modification. Primary and secondary feather loss and subsequent primary feather growth were all significantly increased by the WSU light program at 56, 84, and 112 days. Total and average growth of new primaries was significantly increased by MR at 56 days and total primary feather growth by .65% TSAA at 112 days. No effects due to AA were observed. Photoperiod had the greatest effect on molt per se, with MR and .65% TSAA increasing early and late growth, respectively.

Animal Nutritional Physiological Phenomena↗
PubMed2004

Improving the immunization and health status of children in the Women, Infants, and Children (WIC) Program.

Maintaining enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and continued exposure of these children to immunization-promoting and nutritional benefits within the program is essential to improve the health status of this vulnerable population. Logistic regression was used to determine characteristics of 2 groups of children: those who dropped out of the program despite being eligible and those who remained in the program but were underimmunized. Of over 20,000 children 19-35 months old, 49% had participated in WIC but only 50% were still enrolled. Factors most strongly associated with dropping out of the program were older age of child; white, black, or American Indian race; living in an urban or suburban area; higher socioeconomic status but still eligible for the program; having only 1 child at home; and having mothers who were unmarried or less than 30 years old (p<0.05). Among current participants, factors most strongly associated with under-vaccination included younger age of the child; black or Asian race; moving from another state since birth; mother with less than a high-school education; and having 2 or more children under 18 years old living in the household (p<0.05). Routinely collected child/family information can be used to target outreach and immunization-promoting interventions toward children most likely to drop out of the program or to be underimmunized.

Aid to Families with Dependent Children↗
PubMed1987

Effect of lighting program and nutrition on reproductive performance of molted single comb White Leghorn hens.

Two adjoining rooms in a light-tight, fan-ventilated, insulated house were used for a study involving 320 Single Comb White Leghorn hens, 60 wk of age, placed two per cage. These hens were subjected to an induced molt which compared two lighting programs, two molt rations, two levels of total sulfur amino acids (TSAA), and two levels of ascorbic acid (AA) in a factorial arrangement. There were four treatments. Treatment 1 compared the Washington lighting program (WSU), consisting of an 8-h light photoperiod for 28 days beginning 7 days before fast with the North Carolina program (NCSU), consisting of a 24-h light photoperiod for 7 days prior to fast followed by 12 h light/day for 21 days. After 28 days, light duration was increased to 16 h/day in stages for both programs. Treatment 2 consisted of feeding cracked corn (CC) or 16% protein molt ration (MR) for 2 weeks: Treatment 3, feeding of 14% layer mash with either .60% or .65% TSAA; and Treatment 4, addition of either 0 or 50 ppm AA to the 14% layer mash. After molting, egg production was increased in the NCSU lighting program and .65% TSAA treatments. Feed conversion was improved by the NCSU lighting treatment. Deaths were fewer in diets with 50 ppm AA. Egg weight, specific gravity, and shell weight were not affected by any treatment. A significant light X molt diet interaction occurred due to better performance of MR birds compared with CC birds in the NCSU lighting program, whereas on the WSU lighting program, CC produced better performance. These data indicated that combining features of various molt programs may not produce optimum results.

Animal Husbandry↗
PubMed1993

[Effectiveness of a nutritional education program in lowering blood cholesterol levels in a public health center].

An educational program for persons found to have high blood cholesterol during health examinations at the Nerima Public Health Center was begun in April, 1989. This program was differed from the usual program in two areas. First, new educational material was developed consisting of a check list of 30 items to assess eating patterns. By checking these items, participants could gain an understanding of what they should change in their eating behavior. Secondly, the table of restricted foods was not used. Participants were advised to achieve healthy eating patterns and followed up with a nutritional consultation that was held after three months, at which time they were interviewed regarding compliance and had their blood cholesterol levels measured. The effectiveness of the new educational program and the relationship between achievement of healthy eating patterns and reduction in blood cholesterol levels were analyzed. The main results were as follows: 1) In subjects (n = 79) who received the new education program in 1989-1990, serum cholesterol levels showed significant reduction, as compared with controls (n = 38) who received the usual education program in 1988-1989. 2) Subjects were divided into three groups according to their changes in serum cholesterol levels,--normalized, improved and unimproved--and the number of items complied with were counted for analysis. The mean score of compliance was highest in the normalized group with significant difference between the normalized and the unimproved groups. 3) The items of the high compliance score in the normalized group were in order of high score "to decrease high-fat meats", "to decrease cakes", "to choose lean meats and poultry without skin" and "to eat vegetables at every meal".

Dietetics↗
PubMed2004

Preventing substance use and disordered eating: initial outcomes of the ATHENA (athletes targeting healthy exercise and nutrition alternatives) program.

OBJECTIVES: To implement and to assess the efficacy of a school-based, sport team-centered program to prevent young female high school athletes' disordered eating and body-shaping drug use. DESIGN AND SETTING: Prospective controlled trial in 18 high schools, with balanced random assignment by school to the intervention and usual-care control conditions. PARTICIPANTS: We enrolled 928 students from 40 participating sport teams. Mean age was 15.4 years, 92.2% were white, and follow-up retention was 72%. INTERVENTION: The ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternative) curriculum's 8 weekly 45-minute sessions were incorporated into a team's usual practice activities. Content was gender-specific, peer-led, and explicitly scripted. Topics included healthy sport nutrition, effective exercise training, drug use and other unhealthy behaviors' effects on sport performance, media images of females, and depression prevention. MAIN OUTCOME MEASURES: We assessed participants by confidential questionnaire prior to and following their sport season. We determined program effects using an analysis of covariance-based approach within the Generalized Estimating Equation framework. RESULTS: Experimental athletes reported significantly less ongoing and new use of diet pills and less new use of athletic-enhancing substances (amphetamines, anabolic steroids, and sport supplements) (P<.05 for each). Other health-harming actions also were reduced (less riding with an alcohol-consuming driver [P = .05], more seat belt use [P<.05], and less new sexual activity [P<.05]). The ATHENA athletes had coincident positive changes in strength-training self-efficacy (P<.005) and healthy eating behaviors (P<.001). Reductions occurred in intentions toward future use of diet pills (P<.05), vomiting to lose weight (P<.05), and use of tobacco (P<.05) and muscle-building supplements (P<.005). The program's curriculum components were altered appropriately (controlling mood [P<.005], refusal skills [P = .05], belief in the media [P<.005], and perceptions of closest friends' body-shaping drug use [P<.001]). CONCLUSIONS: Sport teams are effective natural vehicles for gender-specific, peer-led curricula to promote healthy lifestyles and to deter disordered eating, athletic-enhancing substance use, and other health-harming behaviors.

Adolescent↗