Alice S. Ammerman

Improving dietary behavior: the effectiveness of tailored messages in primary care settings.

OBJECTIVES To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. METHODS Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. RESULTS The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. CONCLUSIONS Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention.

A systematic review of fast food access studies.

The frequent consumption of energy‐dense fast food is associated with increased body mass index. This systematic review aims to examine the methodology and current evidence on fast food access and its associations with outcomes. Six databases were searched using terms relating to fast food. Only peer‐reviewed studies published in English during a 10‐year period, with data collection and analysis regarding fast food access were included. Forty articles met the aforementioned criteria. Nearly half of the studies (n = 16) used their own set of features to define fast food. Studies predominantly examined the relationship between fast food access and socioeconomic factors (n = 21) and 76% indicated fast food restaurants were more prevalent in low‐income areas compared with middle‐ to higher‐income areas. Ten of 12 studies found fast food restaurants were more prevalent in areas with higher concentrations of ethnic minority groups in comparison with Caucasians. Six adult studies found higher body mass index was associated with living in areas with increased exposure to fast food; four studies, however, did not find associations. Further work is needed to understand if and how fast food access impacts dietary intake and health outcomes; and if fast food access has disparate socioeconomic, race/ethnicity and age associations.

A Social Media-Based Physical Activity Intervention A Randomized Controlled Trial

BACKGROUND Online social networks, such as Facebook™, have extensive reach, and they use technology that could enhance social support, an established determinant of physical activity. This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity. PURPOSE To test the efficacy of a physical activity intervention that combined education, physical activity monitoring, and online social networking to increase social support for physical activity compared to an education-only control. DESIGN RCT. Students (n=134) were randomized to two groups: education-only controls receiving access to a physical activity-focused website (n=67) and intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group (n=67). Recruitment and data collection occurred in 2010 and 2011; data analyses were performed in 2011. SETTING/PARTICIPANTS Female undergraduate students at a large southeastern public university. INTERVENTION Intervention participants were encouraged through e-mails, website instructions, and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity-themed Facebook group. Participants received access to a dedicated website with educational materials and a physical activity self-monitoring tool. MAIN OUTCOME MEASURES The primary outcome was perceived social support for physical activity; secondary outcomes included self-reported physical activity. RESULTS Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time. Facebook participants posted 259 times to the group. Two thirds (66%) of intervention participants completing a post-study survey indicated that they would recommend the program to friends. CONCLUSIONS Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls. Given their promising features and potential reach, efforts to further understand how online social networks can be used in health promotion should be pursued. TRIAL REGISTRATION This study is registered at clinicaltrials.govNCT01421758.

Farmers’ market use is associated with fruit and vegetable consumption in diverse southern rural communities

BackgroundWhile farmers’ markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers’ markets among rural residents. Thus, this study’s purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers’ market shopping in southern rural communities; and (3) associations between farmers’ market use with fruit and vegetable consumption and body mass index (BMI).MethodsCross-sectional surveys were conducted with a purposive sample of farmers’ market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers’ markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers’ market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers’ market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers’ market shopping. Linear regression analyses were used to examine associations between farmers’ market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender.ResultsAmong farmers’ market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers’ market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers’ market shopping were market days and hours, “only come when I need something”, extreme weather, and market location. Among the KY farmers’ market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers’ markets. There were no associations between use of farmers’ markets and BMI.ConclusionsFruit and vegetable consumption was associated with farmers’ market shopping. Thus, farmers’ markets may be a viable method to increase population-level produce consumption.

Research expectations among African American church leaders in the PRAISE! project: A randomized trial guided by community-based participatory research

OBJECTIVES This study sought to examine the expectations and satisfaction of pastors and lay leaders regarding a research partnership in a randomized trial guided by community-based participatory research (CBPR) methods. METHODS Telephone and self-administered print surveys were administered to 78 pastors and lay leaders. In-depth interviews were conducted with 4 pastors after study completion. RESULTS The combined survey response rate was 65%. Research expectations included honest and frequent communication, sensitivity to the church environment, interaction as partners, and results provided to the churches. Satisfaction with the research partnership was high, but so was concern about the need for all research teams to establish trust with church partners. CONCLUSIONS Pastors and lay leaders have high expectations regarding university obligations in research partnerships. An intervention study based on CBPR methods was able to meet most of these expectations.

Environmental, policy, and cultural factors related to physical activity among Latina immigrants

SUMMARY According to national surveillance studies, participation in leisure-time physical activity remains low among minority women. Fur thermore, the correlates of such activity in this group are not well understood. To better understand the environmental, policy, and sociocultural correlates of physical activity among Latina immigrants, six focus groups were conducted in rural North Carolina. Among the 49 participants, median age was 32 years and median education 11 years. Participants were first generation immigrants from Mexico (n = 43), El Salvador (n = 3), Colombia (n = 1), the Dominican Republic (n = 1), and Honduras (n = 1). Environmental and policy barriers to activity were identified, including transportation, lack of facilities, cost, and safety. Sociocultural correlates of activity included gender roles for activity, importance of support from the family and husband, child care issues tied to having few relatives who lived close by, language, and isolation in the community. The women suggested changes and programs that could promote physical activity through multiple channels, especially involving the family. This information can be used to develop culturally appropriate interventions to increase physical activity among Latinas.

Applying the RE-AIM framework to assess the public health impact of policy change

Background and Purpose: Planning and evaluation models have been developed to assess the public health impact of health promotion interventions. However, few have been applied to health policies. There is an important need for models to help design and evaluate health policies.Methods: This article applies the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework to health policies. We provide definitions and application examples for different policies.Results: As demonstrated by a case study, the RE-AIM dimensions and definitions can also apply to policies. Considerations regarding compliance and enforcement are presented to clarify the complex implementation dimension.Conclusions: The RE-AIM framework can be useful in estimating public health impact, comparing different health policies, planning policies designed for increased likelihood of success, and identifying areas for integration of policies with other health promotion strategies.

Starting the conversation: Performance of a brief dietary assessment and intervention tool for health professionals

INTRODUCTION For chronic disease prevention and management, brief but valid dietary assessment tools are needed to determine risk, guide counseling, and monitor progress in a variety of settings. Starting The Conversation (STC) is an eight-item simplified food frequency instrument designed for use in primary care and health-promotion settings. PURPOSE This report investigates the feasibility, validity, and sensitivity to change of the STC tool, a simplified screener instrument for assessment and counseling. METHODS Data from an ongoing practical efficacy study of type 2 diabetes patients in a diverse population (N=463) were used to document STC validity, robustness, stability, and sensitivity to change from baseline to 4 months. Data were collected from 2008 to 2010, and they were analyzed for this report in 2010. RESULTS The eight STC items and summary score performed well. STC items and the summary score were moderately intercorrelated (r =0.39-0.59, p<0.05). The STC summary score was significantly correlated with the NCI fat screener at baseline (r =0.39, p<0.05), and change in the STC summary score correlated with reduction in percentage of calories from fat (r =0.22, p<0.05) from baseline to 4 months. The STC was sensitive to the intervention, with intervention participants improving significantly more than controls on the summary score (M=1.16 vs 0.46, p<0.05). CONCLUSIONS The brief STC is a relatively simple, valid, and efficient tool for dietary assessment and intervention in the clinical setting. It is available in English and Spanish and is in the public domain. Researchers and practitioners are encouraged to assess its utility in other settings and with other dietary interventions.

Reliability and validity of a nutrition and physical activity environmental self-assessment for child care

BackgroundFew assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed.MethodsTo measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment.ResultsFor inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%.ConclusionThis study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.

Perceived and objective measures of the food store environment and the association with weight and diet among low-income women in North Carolina.

OBJECTIVE The present study aimed to highlight the similarities and differences between perceived and objective measures of the food store environment among low-income women and the association with diet and weight. DESIGN Cross-sectional analysis of food store environment. Store level was characterized by: (i) the availability of healthy foods in stores where participants shop, using food store audits (objective); and (ii) summary scores of self-reported perception of availability of healthy foods in stores (perceived). Neighbourhood level was characterized by: (i) the number and type of food stores within the census tract (objective); and (2) summary scores of self-reported perception of availability of healthy foods (perceived). SETTING Six counties in North Carolina. SUBJECTS One hundred and eighty-six low-income women. RESULTS Individuals who lived in census tracts with a convenience store and a supercentre had higher odds of perceiving their neighbourhood high in availability of healthy foods (OR = 6.87 (95 % CI 2.61, 18.01)) than individuals with no store. Overall, as the number of healthy foods available in the store decreased, the probability of perceiving that store high in availability of healthy foods increased. Individuals with a supercentre in their census tract weighed more (2.40 (95 % CI 0.66, 4.15) kg/m2) than individuals without one. At the same time, those who lived in a census tract with a supercentre and a convenience store consumed fewer servings of fruits and vegetables (-1.22 (95 % CI -2.40, -0.04)). CONCLUSIONS The study contributes to a growing body of research aiming to understand how the food store environment is associated with weight and diet.