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PubMed1991

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The Working Well Trial: baseline dietary and smoking behaviors of employees and related worksite characteristics. The Working Well Research Group.

BACKGROUND: The Working Well Trial, the largest randomized worksite health promotion trial to date, tests the effects of cancer prevention and control interventions on dietary and smoking behaviors of employees and the worksite environment. The trial is a 5-year cooperative agreement conducted in 57 matched pairs of worksites in 16 states by four study centers, a coordinating center, and the National Cancer Institute. The dual aims of this paper are to: (a) present a baseline description of the dietary and smoking habits of 20,801 employees, who are predominantly blue-collar workers; and (b) describe the social and physical environments of their worksites that may facilitate or hinder health behavior changes. METHODS: The self-administered baseline survey of individuals consisted of a core set of questions common across all study centers on diet and smoking. The organizational survey consisted of eight instruments administered via interviews with key informants in each worksite. Continuous variable were analyzed by a mixed linear model and binary data were analyzed by the Generalized Estimating Equation. RESULTS: The population represented is largely male (67.5%) and blue collar (53.5%). Mean levels of fat and fiber intakes were close to the national averages (36.6% of calories as fat and 13.1 g of fiber). Smoking prevalence (25.2%) was slightly lower than the national average. The worksites had a high level of health promotion activities (42% had nutrition programs, 53% had smoking control programs), but lacked environmental support for dietary behavior change and perceived support for smoking cessation. CONCLUSIONS: These findings replicate and extend previous research results to a large sample of diverse, largely blue-collar worksites. In addition the baseline results lay a foundation for the development of new insights into the relationship between individual and organizational level variables that may interact to influence behavioral and cultural norms.

Adult↗
PubMed2001

Predictors of dietary milk fat intake by preschool children.

BACKGROUND: High-fat whole milk is the major dietary source of total and saturated fat for young children. Children from low-income families have higher total and saturated fat intakes and their parents have higher rates of cardiovascular disease compared with children from higher income families. We identified factors that predict the use of either high-fat whole milk or low-fat (1% and/or skim) milk by children to facilitate the development of targeted intervention strategies to reduce their dietary fat intakes. METHODS: Adults (91% mothers) with children > or =1 through <5 years of age, participating in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 50 agencies throughout New York State, completed questionnaires. RESULTS: Most (75%) of the 1,938 children drank whole milk, while only 6.9% consumed exclusively 1% and/or skim milk. The children tended to drink the same type of milk as other family members. In multivariate logistic regression, use of whole milk was associated with younger child age, black race or Hispanic ethnicity, parent/guardian belief that whole milk was healthier for children over 2, and parent/guardian having never tried reduced-fat milks (all P < 0.0001). In contrast, use of 1% and/or skim milk was associated with older child age, female gender, nonblack race, older parent/guardian age, parent/guardian belief that reduced-fat milks were healthier for children over 2, and parent/guardian having tried 1%-fat milk (all P < 0.01). CONCLUSIONS: Individualized family-based strategies are needed to target specific behaviors and/or health beliefs held by different parent groups. For example, taste testing might be an effective strategy for parents who have never tasted reduced-fat milk. Interventions to overcome cultural barriers to the use of low-fat milk may require changing parental health beliefs, in addition to providing education about the health benefits of low-fat milk.

Adult↗
PubMed1988

A simulation based decision support system for a health promotion center.

This study represents the financial and qualitative evaluation of a Health Promotion Center of a private hospital located in a medium-sized town located in a predominantly agricultural area. The major objective of this study was to evaluate the impact of various pricing, advertising, and service strategies on profitability. The result is a pricing strategy which allows the center to reach their financial goal of breaking even while maintaining their service policies. The hospital, which serves a community of 500,000 people, recently developed a new concept called a "Health Promotion Center" (HPC). The HPC provides services such as fitness programs, nutrition awareness, rehabilitation and therapy, and child and adult care. For this purpose, a new building was constructed and the center became operational in June 1983. A variety of management options available to the center are described with evaluations of their usefulness. Evaluation methods include scenarios, stochastic simulations, and analyses of how the decision makers use these methods. The inclusion of risk management, model flexibility, and user involvement are stressed throughout the paper and are critical in the decision process.

Child↗
PubMed1982

Impaired absorptive capacity for carbohydrate in the aging human.

Breath hydrogen (H2) analysis was utilized to determine whether intestinal absorption of carbohydrate might decline with age. Twenty-one healthy subjects (aged 65-89 years, mean age 79.1) and 19 control subjects (aged 20-64 years, mean age 35.6) were fed a meal containing 100 g carbohydrate after an overnight fast. Breath H2 concentrations were analyzed in samples collected intermittently by the end-expiratory technique. A rise in breath H2 concentration of 20 ppm over baseline was considered evidence of intestinal carbohydrate malabsorption: 7 of 21 aged and 0 of 19 control subjects excreted excess H2 (P less than 0.02). Further testing of subjects with meals containing 25-200 g carbohydrate demonstrated a progressive reduction in absorptive capacity with advancing age, while young controls absorbed up to 200 g carbohydrate in a meal. In the group of older subjects carbohydrate malabsorption was not accompanied by clinical determinants of undernutrition. Subtle carbohydrate malabsorption should be considered when evaluating weight loss in old age and in fashioning nutritional programs for the elderly.

Aged↗
PubMed1993

Acute toxicity of vitamin A given with vaccines in infancy.

A double-blind, randomised, placebo-controlled trial was conducted to evaluate the safety and toxicity of vitamin A supplementation within the Expanded Programme on Immunisation (EPI) in rural Bangladesh. 191 infants received 3 doses of either 50,000 IU of vitamin A or placebo at about 1.5, 2.5, and 3.5 months and were examined on days 1, 2, 3, and 8 after supplementation. 11 infants (11.5%) supplemented with vitamin A had episodes of bulging of the fontanelle as opposed to 1 (1%) in the placebo group. 16 of the 17 events occurred in the vitamin A supplemented group. No other side effects were noted. There was a tendency towards a cumulative effect of toxicity with increasing doses.

Bangladesh↗
PubMedDate not supplied

Providing better access to health care: a pediatric nurse practitioner WIC-based clinic for one-stop health care.

The University of Texas Women, Infants, and Children (WIC) Well Child Clinic was established in January 1992 to provide high-quality "user-friendly" health care to children in Houston, Texas. As the name implies, the traditional services of the WIC nutritional program are coupled with primary care to offer more comprehensive and greater access to care. The services are provided by pediatric nurse practitioners and focus on health maintenance, with an emphasis on anticipatory guidance and immunizations. Acute care and management of chronic illness are also provided. The clinic serves as a teaching site for pediatric nurse practitioner and medical students. This article addresses the rationale for and planning of a WIC-based clinic and the implementation of the plan and addresses issues concerning reproducibility in other settings.

Child↗
PubMed2004

Underimmunization in Chicago children who dropped out of WIC.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves a large proportion of Chicago infants, but some discontinue participation before age 1 year. To determine if children who remained active at WIC immunization-linked sites after their first birthday were more likely to be immunized by ages 19 and 25 months than those who dropped out, a retrospective cohort study was conducted. METHODS: Four Chicago WIC sites that used monthly voucher pick-up were chosen. Children born from July 1, 1997 to September 30, 1997 who attended these sites were eligible (N=1142). The cohort was divided into two groups: (1) active group (46%), who had a WIC visit on or after their first birthday; and (2) inactive group (54%), who had their last WIC visit before their first birthday. Children were enrolled through home visits. RESULTS: The records for 200 children were analyzed. By age 19 months, 65 (84%) of 77 active children had received one dose of measles-mumps-rubella vaccine (MMR), compared to 82 (67%) of 123 inactive children (risk ratio [RR]=1.3; 95% confidence interval [CI], 1.1- 1.5). By age 25 months, 64 (83%) active children had received four doses of diphtheria-tetanus-pertussis vaccine (DTP), one MMR, and three doses of Haemophilus influenzae type b vaccine (Hib), compared with 64 (52%) inactive children (RR=1.6; 95% CI, 1.3-2.0). CONCLUSIONS: In this cohort, children active in WIC after their first birthday were more likely to be immunized by ages 19 and 25 months, compared with those who were no longer active. Chicago children who drop out of WIC may represent those at highest risk for underimmunization and may require special strategies to improve coverage.

Bacterial Capsules↗
PubMed2004

A community health center smoking-cessation intervention for pregnant and postpartum women.

OBJECTIVES: To evaluate the effect of a provider counseling and office systems intervention in obstetric, pediatric, and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics on smoking and relapse rates in pregnant and postpartum women. METHODS: Five community health centers were randomized to special intervention (SI) or usual care (UC). Subjects (n =601) were current smokers or had quit with pregnancy. Prenatal and postpartum interviews assessed smoking status and related factors. Data were collected between May 1997 and November 2000. RESULTS: There was a statistically significant difference in 30-day abstinence rates between SI (26%) and UC (12%) conditions at the end of pregnancy among women who had not quit spontaneously with pregnancy (odds ratio [OR]=2.57, p =0.05). This effect remained at 1 month postpartum but was lost at 3- and 6-month postpartum follow-ups. CONCLUSIONS: Brief interventions delivered by healthcare providers during routine prenatal care increased smoking abstinence during pregnancy among women who did not quit spontaneously. Interventions extended into postpartum care did not affect relapse and smoking rates postdelivery.

Adult↗
PubMed2006

Choices made by low-income women provided with an economic supplement for fresh fruit and vegetable purchase.

Vouchers for fresh fruit and vegetable purchase were provided to low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles, CA. As the program is currently constituted, the supplemental foods provided contain no fresh produce except for carrots for exclusively breastfeeding women. This study investigated whether providing supplemental financial support specifically for purchase of fresh fruits and vegetables would result in high uptake of the supplement, and what the individuals would choose to purchase. A total of 602 women enrolling for postpartum services at three selected WIC program sites in Los Angeles were recruited. Sites were assigned to intervention with vouchers redeemable at a local supermarket, a nearby year-round farmers' market, and a control site with a minimal nonfood incentive. Vouchers were issued bimonthly, at the level of US $10/wk, and carried out for 6 months. Of 454 participants who completed the study (75.4%), 86% were Hispanic, 7% non-Hispanic black, and 7% of other ethnic backgrounds. Assessment of uptake was by voucher redemption rates and was approximately 90% for both groups. Participants reported purchasing a wide variety of items at both sites. The 10 most frequently mentioned items were oranges, apples, bananas, peaches, grapes, tomatoes, carrots, lettuce, broccoli, and potatoes. In conclusion, low-income women used the supplement provided almost fully, and purchased a wide variety of fresh fruits and vegetables for their families. No particular barriers arose to redemption of the vouchers by either the participants or the retail vendors.

Adolescent↗
PubMedDate not supplied

Promoting family meals in WIC: lessons learned from a statewide initiative.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in Washington State developed a module to be used at local WIC agencies to promote family meals. Needs assessment and formative evaluation ensured that the module met the needs of WIC staff and clients. The Promoting Family Meals module includes background information on family meals, tools for training WIC staff, outlines for group sessions, handouts tailored to each client's stage of change, children's coloring sheets, bookmarks, banners, and posters. After the first 6 months of use, there was a statistically significant (F = 26.17, df = 3, P < .001) increase in family meal participation in intervention agencies as compared to controls.

Eating↗
PubMed2006

Factors related to overweight and risk for overweight status among low-income Hispanic children.

The purpose of this research was to investigate the agent, host, and environmental factors that are related to overweight status in a sample of low-income Hispanic toddlers who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in a large southwestern city in the United States. Among children at risk for overweight status, the mothers' body mass index (BMI) and the number of servings of fat in the children's daily diet were positively associated with their weight/height percentiles whereas servings of protein in the daily diet and the children's reporting of hunger were negatively associated with their weight/height percentiles. Among overweight children, age was positively associated with their weight/height percentiles. No other variable in the ecological model was associated with normal weight or overweight children and their weight/height percentiles. Different approaches to dietary counseling and health promotion may be indicated based on a child's weight/height percentile or BMI.

Analysis of Variance↗
PubMed2005

Perspectives for artificial insemination and genomics to improve global swine populations.

Civilizations throughout the world continue to depend on pig meat as an important food source. Approximately 40% of the red meat consumed annually worldwide (94 million metric tons) is pig meat. Pig numbers (940 million) and consumption have increased consistent with the increasing world population (FAO 2002). In the past 50 years, research guided genetic selection and nutrition programs have had a major impact on improving carcass composition and efficiency of production in swine. The use of artificial insemination (AI) in Europe has also had a major impact on pig improvement in the past 35 years and more recently in the USA. Several scientific advances in gamete physiology and/or manipulation have been successfully utilized while others are just beginning to be applied at the production level. Semen extenders that permit the use of fresh semen for more than 5 days post-collection are largely responsible for the success of AI in pigs worldwide. Transfer of the best genetics has been enabled by use of AI with fresh semen, and to some extent, by use of AI with frozen semen over the past 25 years. Sexed semen, now a reality, has the potential for increasing the rate of genetic progress in AI programs when used in conjunction with newly developed low sperm number insemination technology. Embryo cryopreservation provides opportunities for international transport of maternal germplasm worldwide; non-surgical transfer of viable embryos in practice is nearing reality. While production of transgenic animals has been successful, the low level of efficiency in producing these animals and lack of information on multigene interactions limit the use of the technology in applied production systems. Technologies based on research in functional genomics, proteomics and cloning have significant potential, but considerable research effort will be required before they can be utilized for AI in pig production. In the past 15 years, there has been a coordinated worldwide scientific effort to develop the genetic linkage map of the pig with the goal of identifying pigs with genetic alleles that result in improved growth rate, carcass quality, and reproductive performance. Molecular genetic tests have been developed to select pigs with improved traits such as removal of the porcine stress (RYR1) syndrome, and selection for specific estrogen receptor (ESR) alleles. Less progress has been made in developing routine tests related to diseases. Major research in genomics is being pursued to improve the efficiency of selection for healthier pigs with disease resistance properties. The sequencing of the genome of the pig to identify new genes and unique regulatory elements holds great promise to provide new information that can be used in pig production. AI, in vitro embryo production and embryo transfer will be the preferred means of implementing these new technologies to enhance efficiency of pig production in the future.

Animals↗
PubMedDate not supplied

Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control.

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.

Adult↗
PubMed2001

Breast-feeding practices among WIC participants in Hawaii.

OBJECTIVE: To describe breast-feeding practices and identify correlates of breast-feeding among participants in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. DESIGN: A cross-sectional survey. SUBJECTS/SETTING: We conducted structured, in-person interviews with 535 women at WIC clinics throughout Hawaii (95% response rate). The interview collected information on maternal characteristics and infant-feeding practices. STATISTICAL ANALYSES: Breast-feeding prevalence was examined by infant age and predictors of infant-feeding method were examined via bivariate tests and multivariable logistic regression analysis. Reported breast-feeding promotion efforts in health care settings outside of WIC were also examined. RESULTS: Most women (82%) attempted to breast-feed, albeit for short durations for many women; of the women who breast-fed in combination with formula feeding, 46% introduced formula within the first week after delivery. Significant predictors of breast-feeding initiation included previous breast-feeding experience, having a close relative or friend who breast-fed, multiparity, Asian/Pacific Island ethnicity (other than Filipino), and being foreign-born. Significant predictors of mixed feeding (vs exclusive breast-feeding) included working or attending school, age less than 20 years, Hawaiian/part Hawaiian or Filipino ethnicity, being Hawaiian-born, and residing in Oahu county. CONCLUSIONS: Although most women in this population initiated breast-feeding, formula was usually introduced at an early age. This study identified several factors associated with breast-feeding initiation and exclusive breast-feeding, factors that may prove useful for the development of appropriate interventions to promote these behaviors.

Adult↗
PubMed1998

Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding.

OBJECTIVE: To evaluate the relative effects introducing motivational videotapes and/or peer counseling in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics serving African-American women have on breast-feeding duration. DESIGN: Experimental intervention study. Pregnant women were enrolled at or before 24 weeks gestation and were followed up until postpartum week 16. Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks postpartum. SUNJECTS/SETTING: One hundred fifteen African-American WIC participants who initiated breast-feeding and who had been enrolled in 1 of 4 clinics. INTERVENTION: Two-by-two factorial design, in which 4 clinics were randomly assigned to receive either no intervention, a motivational video package intervention, a peer-counseling intervention, or both interventions. MAIN OUTCOME MEASURES: Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum. STATISTICAL ANALYSIS PERFORMED: Contingency table analysis, including chi2 tests and log-rank tests; multivariate analysis using Cox proportional hazards regression analysis. RESULTS: A higher proportion of women were breast-feeding at 8 and 16 weeks postpartum in the intervention clinics than in the control clinic. The proportion of women reporting breast-feeding declined at 8 and 16 weeks postpartum, but the rate of decline was slower in the 3 intervention clinics than in the control clinic. Being younger than 19 years of age or older than 25 years of age, having a male infant, and returning to work or school all negatively affected breastfeeding duration, whereas previous breast-feeding experience positively influenced breast-feeding duration. APPLICATIONS/CONCLUSIONS: WIC-based peer counselor support and motivational videos can positively affect the duration of breast-feeding among African-American women. WIC nutritionists and other health professionals in contact with this population should expand their efforts toward promoting increased duration of breast-feeding.

Black or African American↗
PubMed1998

Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery.

OBJECTIVE: To determine the prevalence of pica during pregnancy, maternal hemoglobin levels at delivery, and the association of pica with 2 adverse pregnancy outcomes: low birth weight and preterm birth. DESIGN: A retrospective cohort study was conducted using eligible subjects (n=281) from a cross-sectional survey (n=366). SUBJECTS/SETTING: Mothers aged 16 to 30 years with infants younger than 1 year of age who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interviewed at 4 WIC clinics in Houston and Prairie View, Tex. Medical records from 31 hospitals were abstracted. MAIN OUTCOME MEASURES: Maternal hemoglobin levels at delivery, mean birth weight, and mean gestational age were compared for women who reported pica and women who did not. STATISTICAL ANALYSES: Chi(2) tests, orthogonal t tests, analysis of variance, and regression analysis were used to test the relationships among study variables. RESULTS: Pica prevalence categorized by substance was as follows: ice, 53.7%; ice and freezer frost, 14.6%; other substances such as baking soda, baking powder, cornstarch, laundry starch, baby powder, clay, or dirt, 8.2%; and no pica, 23.5%. Women in all 3 pica groups had lower hemoglobin levels (mean+/-standard deviation, 114+/-12 g/L, 110+/-13 g/L, and 113+/-12 g/L, respectively) at delivery than women who did not report pica (118+/-11 g/L) (P<.01 for all pica groups vs no pica). There were no differences in mean birth weight or mean gestational age of infants born to women from the 3 pica groups and the No Pica group. APPLICATIONS: The findings suggest that pica practices are associated with significantly lower maternal hemoglobin levels at delivery but are not associated with pregnancy outcomes. Dietitians should ask pregnant women with anemia about pica and should counsel women who report pica regarding the health risks associated with it.

Adolescent↗
PubMed1998

Factors associated with fruit and vegetable consumption among women participating in WIC.

OBJECTIVE: The purpose of this analysis was to assess to what extent sociodemographic and psychosocial characteristics predict consumption of fruits and vegetables in women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: Baseline survey data were analyzed for women enrolled in the Maryland WIC 5 A Day Promotion Program, a study sponsored by the National Cancer Institute. Sociodemographic variables included age, race, education, marital status, working status, pregnancy status, and smoking status. Psychosocial variables included self-efficacy, knowledge, attitudes, social support, and perceived barriers to consuming 5 or more servings daily of fruits and vegetables. SUBJECTS/SETTING: Analyses are based on 3,122 women enrolled at 15 WIC sites in Baltimore and 6 counties in Maryland. STATISTICAL ANALYSES PERFORMED: Because psychosocial characteristics were measured on different scales and varied in dispersion, we standardized scores for these variables. Multiple regression analyses were then performed to assess contributions of the sociodemographic variables and the standardized psychosocial variable scores to the variance in consumption of fruits and vegetables. RESULTS: Sociodemographic variables were not powerful predictors of fruit and vegetable consumption. In contrast, an increase of 1 standard deviation in self-efficacy resulted in a mean increase of 0.76 servings, and an increase of 1 standard deviation in perceived barriers resulted in a decrease of 0.50 servings. About 21% of the variance in consumption was explained by all of the variables examined. APPLICATIONS: Dietitians and intervention programs should focus on increasing clients' self-efficacy, positive attitudes, and knowledge relating to fruits and vegetables while trying to reduce perceived barriers to consumption of fruits and vegetables.

Adolescent↗