Barbara Baquero

Away-from-home food intake and risk for obesity: Examining the influence of context

Objective: This study examined sociodemographic and cultural determinants of away‐from‐home food consumption in two contexts and the influence of frequency of away‐from‐home food consumption on childrens dietary intake and parent and child weight status.

Interpersonal and Print Nutrition Communication for a Spanish-Dominant Latino Population: Secretos de la Buena Vida.

Participants (N=357) were randomly assigned to 1 of 3 conditions: lay health advisor (promotora) plus tailored print materials, tailored print materials only (tailored), or off-the-shelf print materials (control). The primary outcomes were calories from fat and daily grams of fiber. Secondary outcomes included total energy intake, total and saturated fat intake, and total carbohydrates. Adjusted for baseline values, calories from fat were 29%, 30%, and 30% for the promotora, tailored, and control conditions, respectively, and grams of fiber consumed were 16 g, 17 g, and 16 g. Significant Condition X Time interactions were not observed between baseline and 12-weeks postintervention. The LHA condition achieved significantly lower levels of energy intake, total fat and saturated fat, and total carbohydrates. The relative superiority of the promotora condition may derive from the personal touch achieved in the face-to-face interactions or from the womens use of print materials under the promotoras guidance.

Development and validation of a scale to measure Latino parenting strategies related to children’s obesigenic behaviors: The Parenting strategies for Eating and Activity Scale (PEAS)

Research has shown that childrens dietary and activity-related behaviors are shaped by the family environment and parenting behaviors. The present study describes the development and validation of a bilingual (Spanish and English) scale assessing parenting strategies associated with childrens dietary and activity-related behaviors in the home. Items were generated from focus groups with Latina mothers and a review of the literature, and two different samples were used to assess the scales psychometric properties, including an examination of predictive validity using measured child body mass index. Factor analysis of the first sample (N=91) yielded a 5-factor solution (limit setting, monitoring, discipline, control and concern) and accounted for 65% of the variance. Confirmatory factor analyses on a second sample of Latina mothers recruited into a childhood obesity prevention study (N=714) showed that a 26-item 5-factor solution (limit setting, monitoring, discipline, control and reinforcement) provided the best fit for the data. Parenting strategies characterized as controlling were associated with a lower BMI among children. After using multiple samples and establishing its validity, the parenting strategies for eating and activity scale (PEAS) was found to be valid and reliable in measuring Latino parenting strategies related to childrens dietary and activity-related behaviors.

Results of a multi-level intervention to prevent and control childhood obesity among Latino children: The Aventuras para niños study

BackgroundCommunity-based interventions are needed to reduce the burden of childhood obesity.PurposeTo evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.MethodsThirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2nd grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.ResultsThere were no significant intervention effects on children’s BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).ConclusionA promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

Leisure-Time Physical Activity in Elementary Schools: Analysis of Contextual Conditions.

BACKGROUND Little is known about childrens leisure-time physical activity (PA) at school and how it is associated with contextual variables. The purpose of this study was to objectively assess childrens voluntary PA during 3 daily periods and examine modifiable contextual factors. METHODS We conducted SOPLAY (System for Observing Play and Leisure Activity in Youth) observations before school, during recess, and at lunchtime in 137 targeted activity areas in 13 elementary schools over 18 months. During observations, each child was coded as Sedentary, Walking, or Vigorous, and simultaneous entries were made for area characteristics (accessibility, usability, presence of supervision, loose equipment, and organized activities). Logistic regression analysis was used to test associations between PA and area characteristics. RESULTS Assessors made 2349 area visits and observed 36,995 children. Boys had more moderate-to-vigorous physical activity (MVPA; 66.2 vs 60.0%, p < .001) and more vigorous PA (29.8 vs 24.6%; p < .001) than girls. Areas were typically accessible and usable, but provided organized activities infrequently (16.5%). Odds of engaging in MVPA were greater during lunch and recess than before school and in areas with play equipment (p < .05). CONCLUSIONS Children accrued a substantial amount of voluntary PA during leisure time at school. Their PA would likely be increased if school playground equipment was more readily available and if supervisors were taught to provide active games and promote PA rather than suppress it.

Individual, social, and environmental barriers to and facilitators of physical activity among Latinas living in San Diego County: focus group results.

The purpose of this study was to examine the barriers to and facilitators of physical activity (PA) relevant to a faith-based community living in a border region. Two focus groups were conducted with 25 Latina churchgoers. Latinas identified barriers to PA that included individual (eg, lack of motivation and time, language, economics, social support, family/household responsibilities), sociocultural (eg, fear of border patrol, machismo, and neighborhood safety), and environmental barriers (eg, traffic-related and dogs). Facilitators of PA were PA knowledge, child care, time management, and advocacy skills. The authors concluded that a church-based multilevel intervention targeting Latinas may be ideal for promoting PA and facilitating environmental changes.

Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers’ intake of fruits and vegetables

OBJECTIVE The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers--specifically customers of tiendas, small-to-medium-sized Latino food stores. DESIGN Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity. SETTING Tiendas in central North Carolina. SUBJECTS Participants included 179 customers who were recent immigrants from Mexico and Central America. RESULTS A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P < or = 0.06). Unexpectedly, self-efficacy for consuming more fruits (P < or = 0.01) and more vegetables (P < or = 0.06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit. CONCLUSIONS Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers’ reported F&V intake. Such strategies can have a public health impact on underserved populations.

Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas

Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US-Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change.

Process Evaluation of a Food Marketing and Environmental Change Intervention in Tiendas That Serve Latino Immigrants in North Carolina

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers’ fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store–based interventions to increase access to and consumption of fruits and vegetables.

What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California

ABSTRACT To inform the design of a multilevel in-store intervention, this qualitative study utilized in-depth semistructured interviews with 28 managers and 10 employees of small-to-medium-sized Latino food stores (tiendas) in San Diego, California, to identify factors within the tienda that may influence Latino customers’ grocery-shopping experiences and behaviors. Qualitative data analysis, guided by grounded theory, was performed using open coding. Results suggest that future interventions should focus on the physical (i.e., built structures) and social (i.e., economic and sociocultural) dimensions of store environments, including areas where the two dimensions interact, to promote the purchase of healthy food among customers.