Beverly McCabe-Sellers

The Association of Child and Household Food Insecurity With Childhood Overweight Status

CONTEXT. The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. OBJECTIVES. The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. METHODS. The National Health and Nutrition Examination Survey 1999–2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (≥85%) or overweight (≥95%) and household and child food security/insecurity using the US Food Security Scale. RESULTS. When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income <100% and >4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes >4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income ≤100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. CONCLUSIONS. Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.

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.

Household Food Insecurity and Obesity, Chronic Disease, and Chronic Disease Risk Factors

ABSTRACT Context. Studies examining the association between food insecurity and obesity in adults have produced conflicting results, and information is limited on the relationship between food insecurity and adult chronic health conditions, particularly in a high-risk population. Objective. To examine the association between household food insecurity and self-reported weight status and chronic disease in the Lower Mississippi Delta. Design. A two-stage stratified cluster sample representative of the population in 36 counties in the Lower Delta. Data were collected in a cross-sectional telephone survey using list assisted random digit dialing telephone methodology. Setting and Participants. A randomly selected sample of 1,457 adults from a free-living population. Main Outcome Measures. US Food Security Survey Module, self-reported height and weight status (obesity = body mass index > 30 kg/m2), and self-reported hypertension, high cholesterol, diabetes, heart disease, stroke, and a marker for metabolic syndrome. Results. In food-insecure adults, 42.3% were obese, a significantly higher rate than food secure adults (33.2%). After controlling for demographic variables, food insecurity was not independently associated with obesity. Income and the interaction between race and gender were significant predictors of obesity. Food insecure adults were significantly more likely to report hypertension (45.1% vs. 29.5%) diabetes (15.0% vs. 9.3%), heart disease (13.5% vs. 6.8%) and metabolic syndrome (10.1% vs. 4.4%). After controlling for demographic variables, food insecurity was associated with high cholesterol (Odds Ratio [OR] 1.65; 95% Confidence Interval [CI], 1.0 to 2.7), heart disease (OR 2.7; 95% CI, 1.5 to 4.8), and metabolic syndrome (OR 2.8; 95% CI, 1.4 to 5.5). Conclusions. The relationship between food insecurity and obesity in a high-risk population, may be due to income and demographic variables. Individuals in a rural high-risk population with high cholesterol, heart disease, and metabolic syndrome have a high likelihood of being food-insecure. Nutritional interventions targeting high-risk populations should address food insecurity.

Personalizing nutrigenomics research through community based participatory research and omics technologies.

Personal and public health information are often obtained from studies of large population groups. Risk factors for nutrients, toxins, genetic variation, and more recently, nutrient-gene interactions are statistical estimates of the percentage reduction in disease in the population if the risk were to be avoided or the gene variant were not present. Because individuals differ in genetic makeup, lifestyle, and dietary patterns than those individuals in the study population, these risk factors are valuable guidelines, but may not apply to individuals. Intervention studies are likewise limited by small sample sizes, short time frames to assess physiological changes, and variable experimental designs that often preclude comparative or consensus analyses. A fundamental challenge for nutrigenomics will be to develop a means to sort individuals into metabolic groups, and eventually, develop risk factors for individuals. To reach the goal of personalizing medicine and nutrition, new experimental strategies are needed for human study designs. A promising approach for more complete analyses of the interaction of genetic makeups and environment relies on community-based participatory research (CBPR) methodologies. CBPRs central focus is developing a partnership among researchers and individuals in a community that allows for more in depth lifestyle analyses but also translational research that simultaneously helps improve the health of individuals and communities. The USDA-ARS Delta Nutrition Intervention Research program exemplifies CBPR providing a foundation for expanded personalized nutrition and medicine research for communities and individuals.

Development and evaluation of WillTry. An instrument for measuring children's willingness to try fruits and vegetables ☆

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure childrens willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test-retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbachs alpha > or = 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5-14 years of age.

A School-Based Fruit and Vegetable Snacking Pilot Intervention for Lower Mississippi Delta Children:

Background. In this pilot study, we examined school-aged children’s familiarity and willingness to try fruits and vegetables (FV) and the impact of a 6-week school-based snack feeding intervention on familiarity and consumption of FV. Methods. In all, 190 fourth- to sixth-grade students from a rural Lower Mississippi Delta (LMD) school participated. Measures included surveys assessing familiarity and willingness to try FV and direct observation of FV snack consumption. Results. At baseline, the majority of students provided correct name recognition for 6 of the 11 snacks offered, whereas name recognition increased significantly for the other 5 FV postintervention. Similarly, previous eating experience increased for 7 of the 11 FV offered. On average, a higher percentage of the fruit (54% to 98%) and vegetable (49% to 50%) snacks offered were consumed by the students. Willingness to try and grade level were the strongest predictors of fruit and vegetable snack consumption. Conclusions. These results sugges...