Barbara Millen Posner

Use of Focus Groups to Explore Nutrition Practices and Health Beliefs of Urban Caribbean Latinos With Diabetes

OBJECTIVE Although Caribbean Latinos are two to three times more likely than non-Hispanic whites to develop diabetes, cultural influences on nutrition and health are poorly understood. To provide insight into important features of diabetes prevention and management, we conducted focus groups to explore nutrition practices and health beliefs. RESEARCH DESIGN AND METHODS Thirty low-income urban Caribbean Latinos with non-insulin-dependent diabetes mellitus (NIDDM) and four familymembers participated in four focus group interviews that were conducted in Boston and Cambridge, Massachusetts. Interviews were conducted in Spanish, were tape recorded, and were led and analyzed by Latino professionals from a community-based health organization. RESULTS Consistent themes described by participants were feelings of social isolation, little understanding of long-term consequences of diabetes, fatalism regarding the course of the disease, multiple barriers todiet and exercise interventions, skepticism regarding the value of preventive health behaviors, prevalent use of traditional nonmedicai remedies, and a clear need for culturally sensitive health-care providers and services. CONCLUSIONS The information from focus groups provides useful information for planning innovative intervention programs for chronic disease risk reduction that emphasize practical skills development, family/peer networks, empowerment techniques, and bilingual providers. We conclude that the focus group technique can be used effectively with low-income, urban minority populations to provide information on lifestyle behaviors and beliefs regarding chronic diseases that impact on health and nutritional status.

Secular Trends in Diet and Risk Factors for Cardiovascular Disease: The Framingham Study

OBJECTIVE In this study we examined changes in dietary intake and risk factors for cardiovascular disease that occurred over three decades in a US-population-based sample. DESIGN Secular trends in dietary profiles and risk factors were studied in cross-sectional samples of subjects from the Framingham Study in 1957-1960, 1966-1969, and 1984-1988. RESULTS Dietary levels of cholesterol appeared to have declined considerably, whereas macronutrient and fatty acid intakes appeared to change only slightly. Men appeared to increase their saturated fat intakes from 16.4% in 1966-1969 to 17.0% in 1984-1988 (P < .01). In spite of relatively stable mean total fat intake levels, 35% to 60% of Framingham Study men and women reported decreased consumption of higher-fat animal products over the 10-year period between 1974-1978 and 1984-1988. Framingham subjects who reported modifying their diets by substituting lower-fat foods for high-fat items between 1974-1978 and 1984-1988 were more likely to achieve the guidelines of the National Cholesterol Education Program and Healthy People 2000 for dietary fat and cholesterol intake and for serum total cholesterol level. Levels of systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and cigarette smoking were also lower in 1984-1988 than in earlier times. Compared with 1957-1960, mean body mass index and prevalence rates of overweight and hypertension were higher in 1984-1988, despite higher levels of reported physical activity. CONCLUSIONS The observed secular trends in diet and risk factor levels for cardiovascular disease in the Framingham population are important to guide the development and implementation of population-based strategies for promoting cardiovascular health, including nutrition interventions.

The Effect of the Food Stamp Program on the Nutrient Intake of the Eligible Elderly

An objective of the Food Stamp Program, recognized in its originating legislation, is to increase the nutrient intake of the poor. Economic theory suggests this might be achieved through income effects and program-related effects. This paper, using data from the Food Stamp Cashout Project, tests the effectiveness of food stamps and direct cash transfers in achieving this goal for a sample of elderly households. Food Stamp Program effects were negligible, and nutrient intake did not increase with income in either program. Controlling for the endogeneity of participation with a selection bias technique did not affect these results.

Diet, menopause, and serum cholesterol levels in women: The Framingham Study

Cross-sectional relationships between diet and total serum cholesterol levels were studied in a sample of 428 women from the Framingham Heart Study Cohort, aged 37 to 70 years, from 1957 to 1960. Multiple linear regression was used to control for total calorie intake, systolic blood pressure, physical activity, Metropolitan relative weight, glucose intolerance, and cigarette smoking. There was little evidence for a relationship between total serum cholesterol and dietary fat intake; whereas a marginally significant direct association was found with total fat in postmenopausal women, total and plant fat and cholesterol were inversely associated, and only cholesterol was significant in premenopausal women. A consistent inverse association was observed between total serum cholesterol levels and intake of protein, particularly from plant sources, and a weak inverse association was found with complex carbohydrate intake. Serum cholesterol in women may be influenced by a number of dietary factors and appears to differ according to menopausal status.

Dietary predictors of serum cholesterol in men: The framingham cohort population

This study examines the cross-sectional relationships between diet and serum cholesterol in a sample of 413 Framingham cohort males, ages 37-70. Regression analyses controlling for age, calories, and coronary heart disease risk factors showed that the direct predictors of serum cholesterol included: fat (g) (p less than 0.05), cholesterol (mg/1000 calories) (p less than 0.05), protein (g and calorie density) (p less than 0.05 and p less than 0.001, respectively), Metropolitan relative weight (p less than 0.05), and systolic blood pressure (p less than 0.001). Fat (calorie density) and cholesterol (mg) were marginally significant direct positive predictors (0.05 less than or equal to p less than or equal to 0.10). Inverse correlates of serum cholesterol were total carbohydrate (g and calorie density) and simple carbohydrate (calorie density) (p less than 0.001). A marginally inverse correlate of serum cholesterol was complex carbohydrate (calorie density) (0.05 less than or equal to p less than or equal to 0.10). These cross-sectional results show that dietary variables predict serum cholesterol levels in men independent of other coronary heart disease risk factors.

The Effects of Cashing out Food Stamps on Food Expenditures

A demonstration program conducted by the U.S. Department of Agriculture at eight sites around the United States tested the concept of food stamp cashout for participants in the Food Stamp Program who are elderly and/or who receive Supplemental Security Income. Participants in the demonstration received their food stamp allotments in the form of cash (checks) rather than as food coupons. The results of the demonstration evaluation suggest that the switch to cashout did not substantially weaken the impacts of the Food Stamp Program on food expenditures.