Anne L. Dorwaldt

Food Preferences Predict Eating Behavior of Very Young Mohawk Children

OBJECTIVE To collect baseline data on energy and nutrient intake and nutrition knowledge, attitudes, and behavior of very young Mohawk children to assist the community in planning an appropriate, targeted nutrition and exercise intervention. DESIGN Energy and nutrient intake data were collected from 24-hour recalls conducted in the childrens homes. Nutrition knowledge, attitudes, and behavior were assessed using a 38-item questionnaire that asked children to report on what foods they like the best, eat most of the time, and think are healthful. The questionnaire was completed in an elementary school on the reservation. Before data collection, we hypothesized that the average diet of the Mohawk children would not meet national dietary recommendations. SUBJECTS One hundred forty-three children, prekindergarten through third grade (aged 4 to 9 years), completed the 24-hour recalls and the questionnaire. An additional 136 children, also prekindergarten through third grade, completed the questionnaire (n = 279). STATISTICS Analysis of variance with a Scheffes multiple-comparison test was used to test for differences among grades and genders for energy and nutrient intake and questionnaire scores. Multiple regression analysis was used to assess the relationship between eating behavior and selected variables. RESULTS A mean daily energy intake of 1,980 kcal consisted of 34% fat, 13% protein, and 52% carbohydrate with 13 g fiber and 235 mg cholesterol. Food preferences were the strongest predictor of behavior, they explained 71% of the variation in the behavior score. APPLICATIONS The major finding of this study, that food preferences are the strongest predictor of reported eating behavior in very young Mohawk children, has implications for behavior change interventions. Focusing on changing what children like to eat, through repeated exposure to new foods in a positive social context, is more likely to change what foods they choose than is simple nutrition education.

Increasing patient/physician communications about colorectal cancer screening in rural primary care practices.

Background:Rural populations as well as less educated people in the United States are less likely to receive colorectal cancer (CRC) screening than people living in urban areas and more educated people. Methods:We tested a computer tablet, Patient/Provider Communication Assistant (PPCA), which collected data, educated patients, and printed personalized notes to patients and providers encouraging conversation about CRC screening. Mixed model analyses using a prepost quasi-experimental design compared patient results during the comparison and intervention periods in 5 rural primary care practices on provider discussion about CRC screening, provider recommendation, and patient intention to be screened. Models including age, education, and literacy measures as covariates were examined. Results:Providers talked with patients about CRC screening in general, and colonoscopy specifically more frequently after the PPCA than with the comparison group (P values = 0.04 and 0.01, respectively). Providers recommended CRC screening more often to patients in the intervention group than to the comparison group (P = 0.02). Patients planned to be screened, specifically with colonoscopy, more frequently after the intervention than in the comparison group (P = 0.003). There were no interactions between group and any of the covariates. Ninety-five percent of the patients, regardless of age or education, found the PPCA easy to use. Conclusions:Results indicated increased provider discussion and recommendation, and patients’ intentions to obtain CRC screening, and in particular colonoscopy, for patients exposed to the intervention, regardless of the patients’ age or literacy levels. The PPCA is a promising intervention method that is acceptable to rural patients.

Youth Audience Segmentation Strategies for Smoking-Prevention Mass Media Campaigns Based on Message Appeal

Mass media interventions are among the strategies recommended for youth cigarette smoking prevention, but little is known about optimal methods for reaching diverse youth audiences. Grades 4 through 12 samples of youth from four states (n = 1,230) rated smoking-prevention messages in classroom settings. Similar proportions of African American, Hispanic, and White youth participated. Impact of audience characteristics on message appeal ratings was assessed to provide guidance for audience segmentation strategies. Age had a strong effect on individual message appeal. The effect of gender also was significant. Message ratings were similar among the younger racial/ethnic groups, but differences were found for older African American youth. Lower academic achievement was associated with lower appeal scores for some messages. Age should be a primary consideration in developing and delivering smoking-prevention messages to youth audiences. The unique needs of boys and girls and older African American adolescents should also be considered.

Evaluation of smoking prevention television messages based on the elaboration likelihood model

Progress in reducing youth smoking may depend on developing improved methods to communicate with higher risk youth. This study explored the potential of smoking prevention messages based on the Elaboration Likelihood Model (ELM) to address these needs. Structured evaluations of 12 smoking prevention messages based on three strategies derived from the ELM were conducted in classroom settings among a diverse sample of non-smoking middle school students in three states (n = 1771). Students categorized as likely to have higher involvement in a decision to initiate cigarette smoking reported relatively high ratings on a cognitive processing indicator for messages focused on factual arguments about negative consequences of smoking than for messages with fewer or no direct arguments. Message appeal ratings did not show greater preference for this message type among higher involved versus lower involved students. Ratings from students reporting lower academic achievement suggested difficulty processing factual information presented in these messages. The ELM may provide a useful strategy for reaching adolescents at risk for smoking initiation, but particular attention should be focused on lower academic achievers to ensure that messages are appropriate for them. This approach should be explored further before similar strategies could be recommended for large-scale implementation.

Motivating Smokers in the Hospital Pulmonary Function Laboratory to Quit Smoking by Use of the Lung Age Concept

INTRODUCTION The purpose of this study was to investigate the use of lung age to motivate a quit attempt among smokers presenting to a hospital pulmonary function testing (PFT) laboratory. METHODS Participants were randomized to receive a lung age-based motivational strategy (intervention group) versus standard care (control group). At 1 month, all participants were interviewed by telephone to determine whether they made a quit attempt. RESULTS A total of 67 participants were enrolled, and 51 completed the study. Baseline mean data included age = 52 years, 70% women, 40 pack-years of smoking, FEV(1) = 69% predicted, and lung age = 83 years. The quit attempt rates were not different between the intervention and control groups (32% vs. 24%, respectively, p = .59). There was a near significant interaction between lung age and intervention strategy (p = .089), with quit attempt rates among those with normal lung age of 18% in the intervention group versus 33% in the control group and among those with high (worse) lung age of 39% in the intervention group versus 17% in the control group; p = .38. CONCLUSIONS Using lung age to motivate smokers presenting to the PFT laboratory to quit may succeed in patients with high lung age but may undermine motivation in smokers with normal lung age. Further work is needed to refine the approach to smokers with normal lung age.

Community-based promotion of breast screening using small group education.

Small Group Education (SGE) to promote breast cancer screening was implemented in a community-wide program. Based on diffusion of innovations theory, SGE initially was directed toward women at higher occupation and education levels and then progressively shifted toward more vulnerable populations of women at risk of not getting screening. During the four-year intervention, 116 volunteers led SGE presentations, with 8,184 women participating in 740 groups at work sites, organizations, residences, and churches. High participation in SGE and positive participant responses suggest that delivery of SGE using a social diffusion model was an effective method for reaching women throughout the community.