Deborah L. Slawson

The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls.

OBJECTIVEnTo determine the efficacy of a 2-year obesity prevention program in African American girls.nnnDESIGNnMemphis GEMS (Girls health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention.nnnSETTINGnLocal community centers and YWCAs (Young Womens Christian Associations) in Memphis, Tennessee.nnnPARTICIPANTSnGirls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher.nnnINTERVENTIONSnGroup behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention).nnnMAIN OUTCOME MEASUREnThe BMI at 2 years.nnnRESULTSnThe BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years.nnnCONCLUSIONSnThe lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention

It is the position of the Academy of Nutrition and Dietetics that primary prevention is the most effective and affordable method to prevent chronic disease, and that dietary intervention positively impacts health outcomes across the life span. Registered dietitians and dietetic technicians, registered are critical members of health care teams and are essential to delivering nutrition-focused preventive services in clinical and community settings, advocating for policy and programmatic initiatives, and leading research in disease prevention and health promotion. Health-promotion and disease-prevention strategies are effective at reducing morbidity and mortality and improving quality of life, and have a significant impact on the leading causes of disease. By applying these principles within a social ecological theoretical framework, positive influence can be applied across the spectrum of engagement: at intrapersonal, interpersonal, institutional, community, and public policy levels. Through the application of efficacious and cost-effective interventions, registered dietitians and dietetic technicians, registered, can positively impact public health as well as health outcomes for the individuals that they counsel. This position paper supports the Practice Paper of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention published on the Academys website at: www.eatright.org/positions.

Go Slow Whoa Meal Patterns: Cafeteria Staff and Teacher Perceptions of Effectiveness in "Winning with Wellness" Schools.

BACKGROUNDnSchool-based interventions hold promise for child obesity prevention. Implemented as a part of the Winning With Wellness obesity prevention project, the Go Slow Whoa meal pattern (GSW) was designed to promote healthier foods in school cafeterias. This investigation determined perceived program effectiveness and impact on students food purchases.nnnMETHODSnA mixed method design was used, including focus groups with cafeteria staff (CS), quantitative analysis of CS and teacher surveys, and pre-post analysis of cafeteria sales. A total of 37 CS and 131 teachers from 7 schools in northeast Tennessee participated.nnnRESULTSnCS recognized the important role of school nutrition services in influencing student choices, yet perceived lack of administrative support for cafeteria-based interventions and minimal interaction with teachers were barriers. CS also believed that students choose less nutritious options due to family influence. Cafeteria sales indicated that changes were made in menu planning and production, yet students choices improved minimally. Teachers expressed moderate levels of confidence in GSW as influential in childrens dietary habits.nnnCONCLUSIONSnSuccessful implementation of school-based nutrition programs requires supportive policies, administrators, and teachers. CS should be included in program implementation efforts and the role of school nutrition services should be maximized.

Practice Paper of the Academy of Nutrition and Dietetics Abstract: The Role of Nutrition in Health Promotion and Chronic Disease Prevention

Food intake, lifestyle behaviors, and obesity are linked to the development of chronic diseases such as type 2 diabetes, certain cancers, and cardiovascular diseases. It is recognized that physical and social environment influences individuals behaviors, and some population subgroups such as racial/ethnic minorities and individuals with low socioeconomic status or limited literacy or language abilities seem to be especially vulnerable to disparities in disease risk factors, disease prevalence, or health outcomes. Certain life cycle phases appear to be especially important for health promotion and disease prevention as the development of chronic diseases can take several decades. Such complex health issues often require system-wide, multifactorial, and multidisciplinary solutions. Social ecological models, with approaches spanning from individual level to macro policy level, can provide registered dietitians (RDs) and dietetic technicians, registered (DTRs) with a comprehensive framework to promote health and to prevent chronic diseases. Furthermore, the Nutrition Care Process can be utilized in carrying out the health promotion and disease prevention efforts. RDs and DTRs have the training and requisite skills to be leaders and active members of multidisciplinary teams to promote health and prevent chronic diseases across the life span. The position of the Academy of Nutrition and Dietetics states that primary prevention is the most effective, affordable method to prevent chronic disease, and that dietary intervention positively impacts health outcomes across the life span. RDs and DTRs are critical members of health care teams and are essential to delivering nutrition-focused preventive services in clinical and community settings, advocating for policy and programmatic initiatives, and leading research in disease prevention and health promotion. In concordance with the Academys position, this practice paper provides an overview of practice examples, effective program components, and a comprehensive range of health promotion and chronic disease prevention strategies for RDs and DTRs. This paper supports the Position of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention published in the July 2013 Journal of the Academy of Nutrition and Dietetics.

Weight status misperception as related to selected health risk behaviors among middle school students.

BACKGROUNDnWeight misperception has been documented among children although the impact on health risk behaviors is less understood, particularly among middle school students. The goals of this study were to describe sociodemographic differences in actual and perceived weight, correspondence between actual and perceived weight, and weight-related health risk behaviors, as well as to examine weight misperception and interactions with sociodemographic variables in explaining weight-related health risk behaviors.nnnMETHODSnParticipants were recruited at 11 public school districts participating in the Tennessee Coordinated School Health (CSH) pilot program. A total of 10,273 middle school students completed the Centers for Disease Control and Preventions Youth Risk Behavior Survey administered by teachers in the school setting.nnnRESULTSnFindings revealed sociodemographic differences in actual and perceived weight as well as weight misperception. Although overestimating ones weight was significantly related to greater likelihood of weight-related health risk behaviors, significant interactions showed this relationship to be especially pronounced in females. Additional distinctions based on sociodemographic variables are indicated.nnnCONCLUSIONSnResults highlight the importance of screening for health risk behaviors including weight misperception among middle school students. The CSH program offers an opportunity to understand health risk behaviors among students while also informing and evaluating methods for intervention.

Prevalence of and Risk Factors for Adolescent Obesity in Southern Appalachia, 2012

The objective of this study was to examine weight status among southern Appalachian adolescents and to identify risk factors for obesity. We analyzed baseline data from the Team Up for Healthy Living study in 2012. Overall, 19.8% of the sample was overweight, and 26.6% was obese. Boys had higher rates of overweight/obesity than girls (50.5% vs 42.3%). Being male (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.39–2.29), having a mother with a high school education or less (OR = 1.39; 95% CI, 1.05–1.83), or having a father with a high school education or less (OR = 1.57; 95% CI, 1.17–2.09) was associated with a higher prevalence of obesity and a higher body mass index z score (β = 0.131, 0.160, and 0.043, respectively, P < .05). Parental education could be used to identify adolescents with a higher likelihood of obesity.

Using the give-get grid to understand potential expectations of engagement in a community-academic partnership.

Research suggests that stakeholder investment is maximized when partnerships understand the assumptions held by partners of the benefits to be derived and contributions to be made to the partnership. In 2011, representatives from seven rural county high schools and five university departments participated in a planning workshop designed to identify elements of an effective community–academic partnership to address adolescent obesity disparity in Southern Appalachia. The purpose of this investigation was to examine key elements of partnership building by way of the Give–Get Grid partnership tool. Content analysis was conducted to identify emerging themes. University representatives consistently identified more proposed program contributions as well as benefits than their high school partners. University personnel responses generally pertained to their level of participation and investment in the partnership, whereas high school personnel tended to identify contributions fundamental to both partnership and program success. Additionally, content analysis uncovered programmatic facilitators and potential barriers that can be instrumental in program planning and forming program messages. Findings suggest that although partners often share common goals, perceptions of the value of investment and benefits may vary. The Give–Get Grid can be used during the program-planning phase to help identify these differences. Implications for practice are discussed.

College students as facilitators in reducing adolescent obesity disparity in Southern Appalachia: Team Up for Healthy Living

The proportion of obese adolescents in Southern Appalachia is among the highest in the nation. Through funding from the National Institute on Minority Health and Health Disparities--National Institutes of Health, the Team Up for Healthy Living project was a cluster-randomized trial targeting obesity prevention in adolescents through a cross-peer intervention. The specific aims of the project were to: 1) develop a peer-based health education program focusing on establishing positive peer norms towards healthy eating and physical activity (PA) among high school students, 2) test program efficacy, and 3) explore mechanisms underlying the program. The study was guided by the Theory of Planned Behavior, which presupposes that human behavior is primarily driven by attitude, subjective norms, perceived behavioral control, and social support. To deliver the intervention, undergraduate students from the disciplines of public health, nutrition, and kinesiology were hired as peer facilitators. Ten area high schools were invited to participate, were matched on demographics and then randomized to intervention or control. The primary outcomes of the study included body mass status, dietary behaviors, PA, and sedentary behaviors which were assessed at baseline and at three and twelve months post baseline. Intervention schools received Team Up for Healthy Living curriculum, which consists of eight 40-minute sessions. The curriculum focused on improving nutrition awareness, PA, leadership and communication. Control schools received their regularly scheduled Lifetime Wellness curriculum. The long-term goal of the study was to establish an effective academia-community partnership program to address adolescent obesity disparity in Southern Appalachia.

Relationship Between Physical Activity and Suicidal Behaviors Among 65,182 Middle School Students

BACKGROUNDnThe psychosocial benefits of participating in physical activity (PA) are well known; less is known about the relationship between suicidal behaviors and PA among adolescents, especially among middle school-aged youth. This study seeks to fill that gap by assessing the cross-sectional relationship between these variables.nnnMETHODSnA secondary analysis of the 2010 Tennessee Middle School Youth Risk Behavior Survey data was conducted among 65,182 middle school students. Items examined were PA, sports team engagement, physical education (PE) class, screen time, suicidal behaviors, drug/substance use, extreme weight control behaviors, weight status and weight misperceptions, and selected personal characteristics. Multiple logistic regression analysis was used to estimate the association between PA, sports team engagement, and PE class attendance on suicidal behaviors.nnnRESULTSnSports team engagement was significantly associated with suicidal thoughts, plans, and attempts even after controlling for other important variables. There was no relationship, however, between total PA or PE class attendance in univariate or multivariate models, respectively.nnnCONCLUSIONSnFindings suggest that sports team engagement is associated with reduced risk for suicidal thoughts, plans, and attempts, whereas, no relationships were found for PA or PE class attendance. Asking adolescents questions about sports team engagement may help clinicians screen for risk of suicidal behaviors.

Weight Misperception and Health-Related Quality of Life in Appalachian Adolescents in the United States

Introduction There is limited research on the relation between weight misperceptions and health-related quality of life (HRQoL) among U.S. adolescents. Methods Baseline data (nxa0=xa01509) collected in 2012 from the Team Up for Healthy Living project were used. Measures included BMI percentiles calculated from measured height and weight; self-perception of weight status; and the 23-item PedsQL™ Inventory. Multiple linear regression was performed after adjustment for covariates to examine associations between weight misperception and HRQoL. Results Compared to accurate weight perception, weight underestimation was associated with higher total HRQoL (βxa0=xa02.41), physical health (βxa0=xa02.77), and emotional (βxa0=xa02.83), social (βxa0=xa02.47) and psychosocial functioning (βxa0=xa02.38) (all pxa0<xa00.05). Weight overestimation was associated with lower social functioning (βxa0=xa0−13.13, pxa0<xa00.05). Stratified by gender, associations were observed only in males. Discussion Weight underestimation had greater association with HRQoL than weight overestimation; and varied by gender. Better understanding of these associations will assist in improving the health of adolescents in Southern Appalachia.