Bernestine B. McGee

Validity of a Telephone-Administered 24-Hour Dietary Recall in Telephone and Non-Telephone Households in the Rural Lower Mississippi Delta Region

OBJECTIVE To determine if 24-hour dietary recall data are influenced by whether data are collected by telephone or face-to-face interviews in telephone and non-telephone households. DESIGN Dual sampling frame of telephone and non-telephone households. In telephone households, participants completed a 24-hour dietary recall either by face-to-face interview or telephone interview. In non-telephone households, participants completed a 24-hour dietary recall either by face-to-face interview or by using a cellular telephone provided by a field interviewer. SUBJECTS/SETTING Four hundred nine participants from the rural Delta region of Arkansas, Louisiana, and Mississippi. MAIN OUTCOME MEASURES Mean energy and protein intakes. STATISTICAL ANALYSES PERFORMED Comparison of telephone and non-telephone households, controlling for type of interview, and comparison of telephone and face-to-face interviews in each household type using unpaired t tests and linear regression, adjusting for gender, age, and body mass index. RESULTS Mean differences between telephone and face-to-face interviews for telephone households were -171 kcal (P = 0.1) and -6.9 g protein (P = 0.2), and for non-telephone households -143 kcal (P = 0.6) and 0.4 g protein (P = 1.0). Mean differences between telephone and non-telephone households for telephone interviews were 0 kcal (P = 1.0) and -0.9 g protein (P = 0.9), and for face-to-face interviews 28 kcal (P = 0.9) and 6.4 g protein (P = 0.5). Findings persisted when adjusted for gender, age, and body mass index. No statistically significant differences were detected for mean energy or protein intake between telephone and face-to-face interviews or between telephone and non-telephone households. APPLICATIONS/CONCLUSIONS These data provide support that telephone surveys adequately describe energy and protein intakes for a rural, low-income population.

Perceptions of Factors Influencing Healthful Food Consumption Behavior in the Lower Mississippi Delta: Focus Group Findings

OBJECTIVE To identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD. DESIGN Nine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change. SETTING Nine counties in Arkansas, Louisiana, and Mississippi. PARTICIPANTS The study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions. ANALYSIS Data analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior. RESULTS The study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control. CONCLUSIONS Focus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Food Shopping Perceptions, Behaviors, and Ability to Purchase Healthful Food Items in the Lower Mississippi Delta

OBJECTIVE To examine the agreement between perceptions, behaviors, and ability to purchase healthful food in the Lower Mississippi Delta (LMD). DESIGN A regional food store survey of healthful food options in supermarkets, small/medium stores, and convenience stores. Focus group discussions were conducted on shopping perceptions and behaviors. SETTING Counties in Arkansas, Louisiana, and Mississippi. PARTICIPANTS Eighty-one LMD residents, 18-60+ years of age. MAIN OUTCOME MEASURE Perceptions of healthful food and ability to acquire these food items across store types. ANALYSIS Focus group data were analyzed using thematic coding. Summary food store statistics were weighted, and estimates were constructed using SUDAAN 9. Data triangulation was achieved by comparing focus group findings with food availability data. RESULTS A majority (> 85%) of supermarkets had selected vegetables, breads, and cereals perceived as healthful, whereas availability was limited in small to medium grocery stores and convenience stores. Skim milk, perceived as healthful, was limited in all store types. CONCLUSIONS AND IMPLICATIONS Limited availability and perceived costs of healthful food in the LMD influenced purchasing behaviors. Attitudes and perceptions should be incorporated into intervention development to improve food choices in conjunction with increasing the availability of healthful food in the LMD.

People United to Sustain Health (PUSH): A Community‐Based Participatory Research Study

The prevention of weight gain to address the obesity epidemic rather than weight loss involves promoting small changes in food choices and physical activity. People United to Sustain Health (PUSH) was designed to increase fruit and vegetable consumption, physical activity, and food security to prevent weight gain in rural adults. Forty‐nine participants were randomized into a treatment group which received access to a “Rolling Store,” nutrition education and physical activity, and a control group which received family coping classes. Forty‐one (84%) of participants completed the study. At the end of 6 months, weight for all participants was maintained from baseline to completion with no significant differences between the groups. The mean fruit consumption over 6 months for the treatment group increased and was significantly greater than change in the control group (p = 0.01). This community‐based participatory research study was considered successful because weight gain was prevented.

Perceptions of Food Intake, Physical Activity, and Obesity Among African-American Children in the Lower Mississippi Delta:

Purpose. To explore the nutrition and physical activity perceptions of children for planning a healthy weight curriculum to address childhood obesity in African-American children living in the Lower Mississippi Delta (LMD). Design. Six children’s focus group sessions. Setting. Two Louisiana parishes in the LMD. Subjects. Seventy 8- to 13-year-old African-American children, 46 (66%) females and 24 (44%) males, participated in the focus group sessions. Measures. Interview questions were based on personal and environmental determinants and content and strategies for a healthy lifestyle program for children. Analysis. Focus group discussions were audio recorded and transcribed, observer recorded, and analyzed to identify recurring trends and patterns among focus groups. Content analysis consisted of coding focus group transcripts for recurrent themes and review of data by an independent reviewer to confirm the themes. Results. Emerging themes were categorized as healthy lifestyle opinions within the social cognitive theory constructs of personal and environmental determinants and curriculum content. Conclusion. LMD youth recognized a healthy eating pattern and that overweight and obesity result from poor eating habits and physical inactivity. Children’s food intake pattern did not reflect this understanding, suggesting a need for culturally tailoring an intervention to impact the poor food intake and physical inactivity in two low-income African-American Delta communities.

Psychological Consequences of Obesity in African American Women

Abstract Results from the Tennessee Self-Concept Scale (TSCS) and a social well-being questionnaire administered to obese African American are described. Fifty four subjects were recruited via flyers in churches, community centers and media advertisements. Subjects had to meet four criteria: 1) define themselves as African American; 2) had body mass indices (BMI: kg/m 2 ) greater than 27; 3) be between 20 and 60 years of age, and 4) not be involved in a weight loss program. The TSCS and the social well-being instruments solicited information about self perceptions, general social perceptions and mental/emotional health relative to being overweight. Each subject completed the questionnaires prior to completing a clinical/biochemical assessment. The mean BMI of the population was 34.5. The women expressed dissatisfaction with their physical appearance, felt unattractive by the opposite sex, felt some dissatisfaction with themselves, were unhappy with their weight, had a negative perception of self, and had experienced rejection by others. The findings suggest that various social and psychological stressors are experienced by obese African American women. The presence of these stressors may influence weight loss and maintenance success. The complexity of these stressors strongly suggest the importance of a multidisciplinary approach to weight management and inclusion of a therapeutic alliance and an empathic supportive relationship.