Elena T. Carbone

Randomized Trial of a Tailored Nutrition Education CD-ROM Program for Women Receiving Food Assistance

OBJECTIVE This article describes the development and randomized evaluation of a tailored nutrition education CD-ROM program for participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in North Carolina. DESIGN After randomization to intervention or control groups, participants completed a baseline survey and were resurveyed immediately after program use and 1 to 2 months postintervention. SETTING Two WIC clinics in central North Carolina. PARTICIPANTS A total of 307 respondents to the follow-up survey (response rate 74.8%) comprised the study sample. Participants were female (96%), 20% were pregnant, and 50% were minorities (African American and other). INTERVENTION The interactive CD-ROM consisted of a targeted video soap opera, dietary assessment, and individually tailored dietary feedback and strategies for change. MAIN OUTCOME MEASURES Measures included total fat and fruit and vegetable intake, knowledge of low-fat and infant feeding choices, self-efficacy, and stages of change. ANALYSIS Descriptive statistics assessed baseline comparability of study groups; analysis of covariance and F tests were used to assess program effects at follow-up. RESULTS INTERVENTION group members increased self-efficacy (P <.01) and scored significantly higher (P <.05) on both low-fat and infant feeding knowledge compared with controls. No differential effect was observed for dietary intake variables. CONCLUSIONS AND IMPLICATIONS The findings suggest that one dose of an interactive CD-ROM program can impact mediators of dietary change but may be insufficient to change behavior.

Views and Preferences of Low-Literate Hispanics Regarding Diabetes Education: Results of Formative Research:

Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.

Use of Cognitive Interviewing to Adapt Measurement Instruments for Low-Literate Hispanics

PURPOSE Cognitive interviewing techniques were used to adapt existing measures for use with a population of low-literate Spanish-speaking people with diabetes. METHODS Five individuals of Caribbean origin with diabetes participated in cognitive interviews for 4 instruments (measuring diabetes knowledge, quality of life, self-management, and depression) adapted for oral administration to low-literate individuals. Audiotaped interviews and handwritten notes were subjected to content analysis to identify problems across the 4 instruments as well as specific to a given instrument. RESULTS The following key problems were identified: general instructions were not helpful, items that were not specific enough generated a variety of interpretations, some wording was confusing, abstract concepts were difficult to understand, some terminology was unfamiliar, and interpretation of certain words was incorrect. CONCLUSIONS The data illustrate the usefulness of cognitive interviewing as a first step in the process of adapting measurement instruments.

The Design, Implementation, and Evaluation of Online Credit Nutrition Courses: A Systematic Review

OBJECTIVE To assess how postsecondary online nutrition education courses (ONEC) are delivered, determine ONEC effectiveness, identify theoretical models used, and identify future research needs. DESIGN Systematic search of database literature. SETTING Postsecondary education. PARTICIPANTS Nine research articles evaluating postsecondary ONEC. MAIN OUTCOME MEASURES Knowledge/performance outcomes and student satisfaction, motivation, or perceptions. ANALYSIS Systematic search of 922 articles and review of 9 articles meeting search criteria. RESULTS Little research regarding ONEC marketing/management existed. Studies primarily evaluated introductory courses using email/websites (before 2000), or course management systems (after 2002). None used true experimental designs; just 3 addressed validity or reliability of measures or pilot-tested instruments. Three articles used theoretical models in course design; few used theories to guide evaluations. Four quasi-experimental studies indicated no differences in nutrition knowledge/performance between online and face-to-face learners. Results were inconclusive regarding student satisfaction, motivation, or perceptions. CONCLUSIONS AND IMPLICATIONS Students can gain knowledge in online as well as in face-to-face nutrition courses, but satisfaction was mixed. More up-to-date investigations on effective practices are warranted, using theories to identify factors that enhance student outcomes, addressing emerging technologies, and documenting ONEC marketing, management, and delivery. Adequate training/support for faculty is needed to improve student experiences and faculty time management.

Better newborn vitamin D status lowers Rsv-associated bronchiolitis in infants

Each year 1.5 million children under the age of 5 years die from pneumonia. In the United States, respiratory syncytial virus (RSV) is the number one cause of bronchiolitis and pneumonia in children under 1 year of age. Low serum 25(OH)D is associated with an increased risk of lower respiratory tract infections (LRTI). Two recent studies have provided important information concerning the association between cord blood 25(OH)D and subsequent risk of developing respiratory infection in very young children. These findings support the need in future studies to determine the extent to which an intervention to change the vitamin D status of mothers during pregnancy can reduce the risk of RSV-associated LRTI in their offspring. An answer to this question would have significant worldwide public health importance given the high prevalence of low vitamin D status worldwide and the high mortality burden accompanying infectious lung diseases in young children.

Correlates of smoking cessation at pregnancy onset among Hispanic women in Massachusetts

Purpose. To examine factors associated with smoking cessation at pregnancy onset in Hispanic women. Design. Cross-sectional analysis of baseline data from the prospective Latina Gestational Diabetes Mellitus Study. Setting. Public obstetrical practices of a medical center in Massachusetts, 2000–2004. Subjects. A total of 351 Hispanic (predominantly Puerto Rican) prenatal care patients who smoked in the year prior to pregnancy. Measures. At enrollment, interviewers collected self-reported cigarette smoking prior to and during pregnancy and sociodemographic, health, and acculturation factors. Analysis. Logistic regression and backward elimination procedures were used to determine factors independently associated with quitting. Results. Forty-five percent of women reported quitting smoking at pregnancy onset. In multivariate analyses, women born outside the United States, women with a family history of diabetes, and non–Puerto Rican Hispanics were 32% to 54% more likely to quit smoking. Women with high stress, women with marijuana use, and parous women were 23% to 49% less likely to quit. Women who smoked 20+ cigarettes/d in prepregnancy were less likely to quit smoking (relative risk = .44; 95% confidence interval .27, .65) compared with light smokers. Age, income, body mass index, language preference, prepregnancy exercise, and alcohol consumption were not associated with quitting. Conclusions. Non-U.S. birthplace, family history of diabetes, and non–Puerto Rican ethnicity were associated with quitting smoking at pregnancy onset in Hispanic women. Prepregnancy marijuana use and smoking, parity, and stress were associated with continued smoking.

Can distance education prepare future public health nutritionists? A case study.

OBJECTIVE To assess student retention, readiness, support and outcomes among students completing the Professional Practice Program in Nutrition (PPPN). DESIGN Qualitative evaluation using semistructured, in-depth interviews conducted with PPPN graduates. Course grades, grade point averages, and comprehensive exam results compared 10 PPPN students from 2 cohorts and 72 residential students from 3 cohorts. SETTING The Professional Practice Program in Nutrition was a 3-year, pilot public health nutrition masters (MPH) degree curriculum using distance education (DE) strategies. ANALYSIS Ethnograph was used to assist with qualitative data analysis. Fisher exact test was used to compare quantitative outcomes. RESULTS Qualitative findings revealed that PPPN students were highly motivated, sought out the DE MPH and initially had great support from family and employers; however, support from employers waned over time. Although several challenges to continued enrollment confronted PPPN students, those who completed the MPH all advanced in the workplace. Course grades and grade point averages were similar between the 2 groups. Students in the PPPN were more likely than residential students to retake the comprehensive exam. CONCLUSIONS AND IMPLICATIONS The findings indicate that DE strategies were suitable to deliver an MPH curriculum in nutrition. The majority of PPPN graduates experienced job advancement and demonstrated leadership development.

Impact of Diet-Related Cancer Prevention Messages Written with Cognitive and Affective Arguments on Message Characteristics, Stage of Change, and Self-Efficacy

OBJECTIVE To determine if participants reading messages matched to a preferred style of message argument respond more favorably than participants reading unmatched messages. DESIGN Randomized trial using telephone and in-person surveys and cognitive response interviews. SETTING University campus. PARTICIPANTS Of 125 initially interested, a convenience sample of 100 university employees completed the study (female: 88%, white: 94%, mean age: 43.7). INTERVENTION(S) Participants read 2 print messages written with cognitive (COG) (fact based) or affective (AFF) (story based) arguments. MAIN OUTCOME MEASURE(S) 7-point Likert scale ratings of message appeal, understandability, persuasiveness, and relevance according to classification into 1 of 4 message groups: COG-AFF (mismatched to affective), AFF-COG (mismatched to cognitive), COG-COG (matched cognitive), and AFF-AFF (matched affective). ANALYSIS 1-way analysis of variance (P < or = .05) and systematic review of qualitative interviews. RESULTS The COG-AFF group consistently gave the lowest ratings to the affective messages and the AFF-COG group generally gave high scores compared with other message groups. Participants also expressed a desire for more factual information. CONCLUSIONS AND IMPLICATIONS A combination of cognitive and affective arguments may be appealing to subjects with an affective preference but disliked by individuals who prefer only a fact-based approach. Argument format may be an important message design consideration.

Testing the feasibility of an interactive learning styles measure for U.S. Latino adults with type 2 diabetes and low literacy.

This study designed and piloted an interactive measure to assess learning preferences of Latinos in the United States with diabetes and limited literacy. The measure utilized interactive learning activities to represent four learning styles: visual (seeing), kinesthetic (doing), affective (feeling/sensing), and cognitive (thinking), targeting four diabetes self-management behaviors: choosing healthy foods; understanding portion sizes; distinguishing foods to eat often/sometimes/rarely; and limiting fat. Quantitative data were collected using the Spanish Short Test of Functional Health Literacy in Adults (S-TOFHLA). Individual, structured cognitive interview questions asked participants to identify learning activities that most reflected their own experience with diabetes. Participant observations provided additional qualitative data. Ten Spanish-speaking adults with type 2 diabetes and limited literacy participated in two randomly selected target behaviors and identified easiest and most difficult to understand learning activities. S-TOFHLA scores ranged from 0 to 21 points (mean 7.0) and identified eight participants with inadequate and two with marginal health literacy. Easiest to understand tasks were kinesthetic, most difficult to understand tasks were cognitive. This is one of the first known studies of its kind and offers insight for measuring learning styles of Latinos with diabetes and low health literacy.

Who’s calling for weight loss? A systematic review of mobile phone weight loss programs for adolescents

CONTEXT Adolescent overweight and obesity are ongoing public health concerns, and innovative weight loss interventions are needed to reach this age group. OBJECTIVE The objective of this systematic review was to assess and synthesize the literature on adolescent weight loss programs that utilize cell phones as an intervention component to reduce weight, as measured by body mass index or body mass index z-score. DATA SOURCES A systematic review of the literature, consistent with PRISMA guidelines, was undertaken using 11 databases. STUDY SELECTION Studies of weight loss interventions published in peer-reviewed journals in English during the last 10 years were eligible for inclusion if they examined an adolescent population, used validated measures for pre- and post-test weight, identified weight loss as a primary or secondary outcome, and specified use of cell phones to deliver a component of the program. DATA SYNTHESIS While within-group weight loss results were noted, no significant between-group differences were found across the majority of studies reviewed. Cell phone components were embedded within larger weight loss programs, making it difficult to determine their true effect. CONCLUSIONS Cell phone use is ubiquitous and, as such, may offer an interesting addition or alternative to current weight loss programs, particularly for adolescents who are considered digital natives. Future research in this area should be systematic in design so that the true effect of the individual components (i.e., cell phones) can be detected.