Cristina S. Barroso

Senate Bill 42: Implementation and Impact on Physical Activity in Middle Schools

PURPOSE In 2005, the Texas State Legislature passed Senate Bill 42 (SB42), which required public middle school students (grades 6-8) to participate in 30 minutes of daily structured physical activity. The purpose of this study was to assess awareness of and adherence to SB42 in Texas middle schools, and to assess the impact of SB42 on the frequency and quality of structured physical activity. METHODS Key informant (school principals, physical education [PE] instructors, nurses, or designated personnel) telephone interviews on the implementation of SB42 were conducted from a statewide representative sample of public middle schools (n=112). Direct observation, key informant, and student report of physical activity in PE classes at 17 Texas-Mexico border middle schools assessed the frequency and quality of structured physical activity. RESULTS State level (94% +/- 4.5%) and border district (94% +/- 13.5%) key informants reported a high level of overall awareness of SB42. Postimplementation of SB42 border districts reported a minimum of 4 days per week of PE instruction and more than 58 minutes per PE class, exceeding the 30-minute minimum of structured physical activity per day or 135 minutes per week as required by SB42 (range: 58.2-61.4 minutes). A significant increase in the number of days of PE class was observed in the border sample between 2004 and 2005 and 2006 and 2008, with eighth grade students reporting an average of 2.0 days and 3.7 days of PE per week, respectively (p < .001). Additionally, border districts met the Healthy People 2010 objective of 50% time in moderate-to-vigorous physical activity (mean 54.9% +/- 5.1%) during PE class. CONCLUSIONS Implementation of SB42 appears to have impacted the frequency of school PE in Texas and the prevalence of child self-reported physical activity behaviors along the Texas-Mexico border. General awareness of and adherence to SB42 was high in both statewide and among the border districts. Our mixed findings on adherence to specific components of the legislation suggest the need for further investigation of the factors that both facilitate and inhibit local leadership around school policy and the mechanisms to ensure the school policy is being implemented.

Beliefs and Perceived Norms Concerning Body Image among African-American and Latino Teenagers

Focus groups, utilizing the Theory of Planned Behavior, examined the beliefs and perceived norms regarding body image in a sample of urban African-American and Latino teenagers (N = 83, 18—19 years old) from Texas. Cultural eating (behavioral belief) explained the acceptance and tolerance of overweight. Popularity of hip-hop fashion and limited income explicated peer and familial normative beliefs, respectively. Thinness equated HIV infection in African-Americans (parental normative belief). Barriers to healthy eating and active living (control beliefs) included willpower, laziness, fast food, and excessive work. Findings can guide the development and implementation of culturally appropriate obesity interventions for African-American and Latino adolescents.

Food security, maternal feeding practices and child weight-for-length

BACKGROUND Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity. METHODS This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, childs eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats. RESULTS Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, childs caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00). DISCUSSION Research on food security and childrens weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security. CONCLUSION Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.

Tu Salud, ¡Si Cuenta!: Exposure to a community-wide campaign and its associations with physical activity and fruit and vegetable consumption among individuals of Mexican descent

Mexican Americans along the US-Mexico border have been found to be disproportionately affected by chronic diseases particularly related to lack of physical activity and healthful food choices. A community-wide campaign (CWC) is an evidence-based strategy to address these behaviors but with few examples of implementation in Mexican descent populations facing profound health disparities. We examined exposure to a CWC, titled Tu Salud ¡Sí Cuenta!, and its association with meeting the recommended minutes of moderate and vigorous physical activity weekly and consuming more portions of fruits and vegetables daily. A cross-sectional sample of 1438 Mexican descent participants was drawn from a city-wide, randomly-selected cohort interviewed between the years 2008 and 2012. Multivariable comparisons of participants exposed and not exposed to the CWC and meeting physical activity guidelines or their fruit and vegetable consumptions using mixed effects models were conducted. The community-wide campaign components included different forms of mass media and individually-focused components such as community health worker (CHW) home visits. After adjusting for gender, age, marital status, educational attainment, language preference, health insurance, and diabetes diagnosis, the strongest association was found between meeting physical activity guidelines and exposure to both CHW discussions and radio messages (adjusted OR = 3.83; 95% CI = [1.28, 6.21]; p = 0.0099). Participants who reported exposure to both radio and TV messages consumed more portions of fruits and vegetables than those who reported no exposure (adjusted RR = 1.30; 95% CI = [1.02, 1.66]; p = 0.0338). This study provides insights into the implementation and behavioral outcomes associated with exposure to a community-wide campaign, a potential model for addressing lifestyle modifications in populations affected by health disparities.

Women, Infants, and Children Cash Value Voucher (CVV) Use in Arizona: A Qualitative Exploration of Barriers and Strategies Related to Fruit and Vegetable Purchases

OBJECTIVE Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. DESIGN Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. SETTING Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. PARTICIPANTS Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. PHENOMENON OF INTEREST Perceived barriers to CVV use and strategies used to maximize their purchasing value. ANALYSIS Transcripts were analyzed using a general inductive approach to identify emergent themes. RESULTS Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. CONCLUSIONS AND IMPLICATIONS Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences.

Nativity and Nutritional Behaviors in the Mexican Origin Population Living in the US-Mexico Border Region

The purpose of this study is to determine the relationship between nativity and nutritional behaviors and beliefs in the Mexican American population living in the South Texas border region. Mexican Americans living the border region of South Texas were sampled to assess their nutrition behaviors and beliefs. Nativity was measured as whether subjects were born in the United States or Mexico. Nutritional behaviors were measured using the SPAN and indexes were used to measure barriers to good nutrition, dietary self-efficacy, and dietary importance. OLS regression analysis was used and adjustments were made for sociodemographic factors. Differences between US-born Mexican Americans and Mexico-born Mexican Americans existed in nutritional beliefs, but not in behaviors. Mexico-born Mexican Americans reported their dietary choices as more important and reported greater food self-efficacy than their US-born Mexican American counterparts. Socioeconomic status influenced US-born Mexican Americans nutritional beliefs only and the same effect was not observed for Mexico-born Mexican Americans. Despite low levels of overall acculturation in the border region dietary beliefs still exist between immigrants and US-born Mexican Americans in dietary beliefs, but, not behaviors in US-born Mexican Americans.

The Flipped Classroom: Student-Driven Library Research Sessions for Nutrition Education

This article reports on the use of a flipped classroom technique to teach library research skills to upper-level undergraduate nutrition students. A public university Health Sciences librarian and two Nutrition faculty members collaborated to implement a flipped classroom model utilizing online videos and brief assignments packaged in a course-specific library guide for pre-class preparation. Implementation, materials examples, and an evaluation of the method are included. This method provided pre-class learning and increased in-class, hands-on practice in library research for students in an active learning environment. Students found and applied evidence from scientific research studies to course assignments.

Effects of a diabetes prevention programme on weight-specific quality of life in Latino youth

To examine the effects of a diabetes prevention programme on weight‐specific Quality of Life (QOL) in obese Latino youth.

Maternal health of undocumented women with and without medicaid access in Nebraska, 2007-2011

Introduction: Four million infants are born in the United States to undocumented mothers. Nebraska granted Medicaid access to undocumented pregnant women from 1996 to 2010 and then discontinued access from 2010 to 2012. However, little is known about the maternal health of these undocumented women. The purpose of this study was to compare maternal health of undocumented women with and without access to Medicaid in Nebraska from 2007 to 2011. Method: A retrospective, longitudinal cohort design was conducted with 2007 to 2011 Nebraska birth certificate data. Study participants were 6,262 undocumented women. Groups of measures were created for demographics, prenatal, pregnancy, and delivery characteristics. Descriptive statistics were calculated and comparisons were conducted between women with and without access to Medicaid using chi-square and Student t tests. Results: More than 60% of undocumented women had access to Medicaid, while 32% had no access to Medicaid. Undocumented women were predominately Hispanic (73.32%) and did not have a high school education (68.77%). The comparison of undocumented women with and without Medicaid revealed that women with Medicaid access had more than adequate prenatal care (17.86% vs. 14.80%) and a higher frequency of infant born with abnormal conditions (6.26% vs. 8.03%). Women without access to Medicaid more often had inadequate prenatal care (10.28% vs. 6.94%) and were obese prior to pregnancy (19.37% vs. 17.37%). Conclusions: Undocumented women who are prenatally obese and lack access to prenatal care may be at increased risk for poor maternal outcomes.