Alexandra Evans

Reductions in Child Obesity Among Disadvantaged School Children With Community Involvement: The Travis County CATCH Trial

The objective of this study was to compare the impact of two intervention approaches on the prevalence of child overweight and obesity: (i) Coordinated Approach To Child Health BasicPlus (CATCH BP), in which schools were provided evidence‐based coordinated school health program training, materials, and facilitator support visits, and (ii) CATCH BP and Community (BPC), in which BP schools received additional promotion of community partnerships with the aim of integrating community members and organizations into schools, local decision making and action, and best practices workshops. Schools (n = 97) in four central Texas districts were recruited to participate in the 4‐year project. Of the low‐income schools (n = 58), 15 schools were selected to receive the BPC intervention and matched with 15 schools in the BP condition. A serial cross‐sectional design was used, in which 4th grade student BMI, physical activity, and diet were assessed in the 30 schools in spring 2007 and 2008. Measurements in spring 2007 included 1,107 students, with 53% female; 61% Hispanic, and 14% African American; and mean age of 9.9 years. Adjusted prevalence of overweight/obesity (≥85th percentile) was 42.0 and 47.4% in spring 2007 for the BP and BPC students, respectively. From spring 2007 to spring 2008, the percent of students classified as overweight/obese decreased by 1.3 percentage points (P = 0.33) in BP schools, compared to a decrease of 8.3 percentage points (P < 0.005) in students from BPC schools; the difference between conditions was significant (P = 0.05). CATCH BPC students also reported more positive trends in related behaviors. Implementation of a community‐enhanced school program can be effective in reducing the prevalence of child overweight in low‐income student populations.

Dietary and Activity Correlates of Sugar-Sweetened Beverage Consumption Among Adolescents

OBJECTIVE: To examine the dietary and activity correlates of sugar-sweetened beverage consumption by children in middle and high school. METHODS: Data were obtained from a cross-sectional survey of 15 283 children in middle and high schools in Texas. Consumption of sodas and noncarbonated flavored and sports beverages (FSBs) were examined separately for their associations with the level of (1) unhealthy food (fried meats, French fries, desserts) consumption, (2) healthy food (vegetables, fruit, and milk) consumption, (3) physical activity including usual vigorous physical activity and participation in organized physical activity, and (4) sedentary activity, including hours spent watching television, using the computer, and playing video games. RESULTS: For both genders, consumption of soda and FSBs was systematically associated with a number of unhealthy dietary practices and with sedentary behaviors. However, consumption of FSBs showed significant positive graded associations with several healthy dietary practices and level of physical activity, whereas soda consumption showed no such associations with healthy behaviors. CONCLUSIONS: Consumption of FSBs coexists with healthy dietary and physical activity behaviors, which suggests popular misperception of these beverages as being consistent with a healthy lifestyle. Assessment and obesity-prevention efforts that target sugar-sweetened beverages need to distinguish between FSBs and sodas.

Associations among Food Insecurity, Acculturation, Demographic Factors, and Fruit and Vegetable Intake at Home in Hispanic Children

The purpose of this cross-sectional pilot study was to examine associations between food insecurity, acculturation, demographic factors, and childrens fruit and vegetable intake among a sample of Hispanic children ages 5 to 12 years. A convenience sample of 184 parents of low socioeconomic status completed one-time, self-administered questionnaires assessing demographic information, acculturation, and food insecurity in the spring of 2006. In addition, childrens fruit and vegetable intake at home was measured using a validated seven-item index. Parents were recruited through local elementary schools in San Antonio, TX. Pearson and Spearman correlations were used to examine the associations between the variables. t tests were used to explore the differences in means of childrens fruit and vegetable intake at home for acculturation and food insecurity levels. Statistical significance was set at P<0.05. Significant correlations were found between demographic variables, acculturation, food insecurity, and childrens fruit and vegetable intake at home. The overall mean fruit and vegetable intake at home was 1.04+/-0.63 (mean+/-standard deviation) servings per day. Higher rates of acculturation and higher rates of food insecurity were associated with lower fruit and vegetable intake at home. The findings reported in this study suggest a need for culturally tailored interventions targeting Hispanic children because fruit and vegetable intake at home among Hispanic children was low, regardless of the level of acculturation or food insecurity.

A qualitative study of parental modeling and social support for physical activity in underserved adolescents

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10-14 years, 85% African-American) participated in a focus group (6-10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.

Computer-assisted instruction: an effective instructional method for HIV prevention education?

PURPOSE To compare the effectiveness of a computer-assisted instruction (CAI)-based intervention to a more traditional lecture-based intervention for influencing psychosocial correlates of human immunodeficiency virus (HIV) preventive behaviors. METHODS Students enrolled in a Human Sexuality course (N = 152) were randomly assigned to one of three groups: CAI, Lecture, or No Intervention group. Participants in the CAI group reviewed a 1-hour long CAI program, participants in the Lecture group were presented with a 1-hour long lecture, and participants in the No Intervention group received no intervention. After completing the respective interventions, all participants completed the HIV questionnaire, which measured selected Social Cognitive Theory constructs associated with HIV preventive behaviors. MANCOVA, ANCOVA and Post Hoc analyses were utilized to test for significant differences among the three groups. RESULTS The analyses disclosed that, compared to participants in the Lecture group, participants in the CAI group scored significantly higher on the scales measuring autoimmune deficiency syndrome (AIDS) knowledge, self-evaluative outcome motivation, and intention to practice HIV preventive behaviors with current partner. In addition, compared to the No Intervention group, the CAI group scored significantly higher on the scales measuring physical outcome motivation and social outcome motivation. CONCLUSIONS CAI-based programs can be effective for delivering instruction on HIV prevention. However, because of certain limitations, this type of program is best utilized as part of a more comprehensive intervention that uses several different delivery systems.

Female adolescents and onset of sexual intercourse: a theory-based review of research from 1984 to 1994.

PURPOSE To review a decade of research on the correlates of early onset of sexual intercourse among female adolescents in the United States, using Social Cognitive Theory as a framework for classification. METHODS Forty-nine studies published in peer-reviewed journals between 1984 and 1994 were reviewed and their findings coded by two independent coders. RESULTS Findings indicate that most of the studies emphasized quantitative methodologies, using cross-sectional designs and univariate statistical analyses. Many studies lacked a theoretical framework or conceptual model to guide their investigations. When evaluating empirical findings, 61% of the studies found environmental correlates and 47% found biological factors (e.g., age and pubertal development) to be significantly associated with early initiation of sexual intercourse. CONCLUSION These findings raise important questions about the quality of research on adolescent sexuality, as well as its relationship to the development of risk-reduction programs which tend to focus mainly on intrapersonal factors (such as attitudes, knowledge, and expectancies.

Maintaining prevention in practice: Survival of PPIP in primary care settings

INTRODUCTION Put Prevention Into Practice (PPIP) consists of a kit of office-based tools intended to support the provision of preventive services by primary care providers. The purpose of this study was to examine the institutionalization of PPIP within five primary care clinics funded by the Texas Department of Health to implement PPIP, and to examine the organizational determinants of program institutionalization. METHODS We utilized an adaptation of the Level of Institutionalizaton (LoIn) scales for qualitative data collection and for development of an institutionalization score for each site. The determinants of institutionalization were derived from the organizational behavior and health promotion literatures and used as categories for analysis. In addition, for purposes of triangulation, chart audit data for three documentation behaviors were also collected. RESULTS PPIP has been maintained--at varying degrees of integration--in four of the five sites studied, for 6 years after adoption. Organizational factors that facilitated the institutionalization process were the sites institutional strength, the integration of PIPP within extant programs and services, visibility of the program within and outside the site, planning for the termination of grant funding, and presence of a program champion with mid- to upper-level managerial authority. Successful initiation of the program was not a predictor of institutionalization outcomes. CONCLUSIONS We have highlighted the need to consider organizational determinants of institutionalization in relation to their specific sociopolitical contexts, and in relation to each other, not in isolation.

Cognitive and home environmental predictors of change in sugar-sweetened beverage consumption among adolescents

Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12-13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR = 0.53). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR = 2.39, 0.54). The association between availability and decrease in SSB consumption was for 68 % mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.

Traditional Foods and Practices of Spanish-Speaking Latina Mothers Influence the Home Food Environment: Implications for Future Interventions

This study aimed to obtain in-depth information from low-income, Spanish-speaking Latino families with young children to guide the development of culturally appropriate nutrition interventions. Focus groups were used to assess parents knowledge about healthful eating, the home food environment, perceived influences on childrens eating habits, food purchasing practices, and commonly used strategies to promote healthful eating among their children. Thirty-four Latino parents (33 women; 27 born in Mexico; 21 food-insecure) of preschool-aged children participated in four focus group discussions conducted in Spanish by a trained moderator. The focus groups were audiotaped, transcribed, translated, and coded by independent raters. Results suggest that in general, parents were very knowledgeable about healthful eating and cited both parents and school as significant factors influencing childrens eating habits; at home, most families had more traditional Mexican foods available than American foods; cost and familiarity with foods were the most influential factors affecting food purchasing; many parents had rules regarding sugar intake; and parents cited role modeling, reinforcement, and creative food preparation as ways to encourage childrens healthful eating habits. Finally, parents generated ideas on how to best assist Latino families through interventions. Parents indicated that future interventions should be community based and teach skills to purchase and prepare meals that include low-cost and traditional Mexican ingredients, using hands-on activities. In addition, interventions could encourage and reinforce healthy food-related practices that Latino families bring from their native countries.

Exposure to Multiple Components of a Garden-Based Intervention for Middle School Students Increases Fruit and Vegetable Consumption

Objectives. (1) To measure the effects of different levels of exposure to a multiple-component garden-based intervention on middle school students’ fruit and vegetable (F&V) consumption and related variables and (2) to determine the separate effects of each of the intervention components on F&V consumption. Design. Unequal treatment–control posttest only. Setting. Five middle schools in ethnically diverse communities. Participants. Two hundred and forty-six adolescents (59% Hispanic; 70% low-income). Intervention. The Sprouting Healthy Kids intervention consists of six components: (1) in-class lessons, (2) after-school gardening program, (3) farm-to-school, (4) farmers’ visits to schools, (5) taste testing, (6) field trips to farms. Outcome measures. F&V consumption; motivation for eating F&V; self-efficacy for eating F&V; F&V preference; preference for unhealthy foods; knowledge. Analysis. Linear regression models controlling for gender, ethnicity/race, and income. Results. Compared with students who were exposed to less than two intervention components, students who were exposed to two or more components scored significantly higher on F&V intake, self-efficacy, and knowledge and lower on preference for unhealthy foods (p < .05). The farmers’ visits, taste testing, and cafeteria components had the largest effect sizes but were not significant. Conclusions and implications. Interventions targeting adolescent F&V behavior change should include multiple components such as farmers’ visits to the school and taste testing.