EunSeok Cha

Health literacy, self-efficacy, food label use, and diet in young adults.

OBJECTIVES To examine relationships among health literacy, self-efficacy, food label use, and dietary quality in young adults aged 18-29. METHODS Health literacy, self-efficacy, food label use, and dietary quality were assessed. Participants were categorized into low, medium and high health literacy groups based on Newest Vital Sign score. RESULTS Self-efficacy and health literacy were predictors of food label use, which positively predicted dietary quality. The low health literacy group had significantly lower use of food labels than the high health literacy group. However, there was no significant difference between medium and high health literacy groups. CONCLUSION Strategies to enhance health literacy, self-efficacy and food label use should be developed to improve dietary quality and health outcomes.

Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants.

Purpose The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds). Methods A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants’ preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings. Results The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship. Conclusions Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.

Testing the Theory of Reasoned Action in Explaining Sexual Behavior Among African American Young Teen Girls

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Characteristics of American young adults with increased risk for type 2 diabetes: a pilot study.

Purpose The purpose of the study was to examine the characteristics of American young adults with increased risk for type 2 diabetes (T2D). Methods Participants ages 18 to 29, overweight/obese, and sedentary were recruited from the metro Atlanta area in the United States. Variables included demographics, anthropometric and clinical variables, and physical activity. Of 107 participants, 3 participants had undiagnosed diabetes and 1 participant did not complete the modifiable activity questionnaire. Thus, 103 young adults remained for the final data analysis. Results Most participants were females and African Americans. About 30% of participants had prediabetes, either impaired fasting glucose, an A1C of 5.7% to 6.4%, or both. Overall, prediabetes young adults were heavier and did less physical activity than Diabetes Prevention Program (DPP) trial participants. In addition, these young adults had a higher prevalence of parental T2D history and lower level of physical activity compared to young adults with normoglycemia. Conclusions Physical activity and parent T2D history are key risk factors for identifying young adults with prediabetes. Multilevel strategies are necessary to raise awareness of diabetes risk and to prevent T2D in young adults.

Educational Needs for Improving Self-Care in Heart Failure Patients With Diabetes

Purpose To explore the need for self-monitoring and self-care education in heart failure patients with diabetes (HF- DM patients) by describing cognitive and affective factors to provide guidance in developing effective self-management education. Methods A cross-sectional correlation design was employed using baseline patient data from a study testing a 12-week patient and family dyad intervention to improve dietary and medication-taking self-management behaviors in HF patients. Data from 116 participants recruited from metropolitan Atlanta area were used. Demographic and comorbidities, physical function, psychological distress, relationship with health care provider, self-efficacy (medication taking and low sodium diet), and behavioral outcomes (medications, dietary habits) were assessed. Descriptive statistics and a series of chi-square tests, t tests, or Mann-Whitney tests were performed to compare HF patients with and without DM. Results HF-DM patients were older and heavier, had more comorbidities, and took more daily medications than HF patients. High self-efficacy on medication and low-sodium diet was reported in both groups with no significant difference. Although HF-DM patients took more daily medications than HF, both groups exhibited high HF medication-taking behaviors. The HF-DM patients consumed significantly lower total sugar than HF patients but clinically higher levels of sodium. Conclusions Diabetes educators need to be aware of potential conflicts of treatment regimens to manage 2 chronic diseases. Special and integrated diabetes self-management education programs that incorporate principles of HF self-management should be developed to improve self-management behavior in HF-DM patients.

A Systematic Review of Transitional Care for Emerging Adults with Diabetes

The prevalence of diabetes and prediabetes in adolescents is increasing. A systematic review of 31 research articles focusing on transitional care for adolescents or emerging adults with diabetes or prediabetes was completed. Studies focused on those with type 1 diabetes, not type 2 diabetes or prediabetes, and were primarily descriptive. Major findings and conclusions include differences in pediatric versus adult care delivery and the importance of structured transitional programs using established recommendations of leading national organizations. Implications include future research on program development, implementation, and evaluation that is inclusive of adolescents and emerging adults, regardless of diabetes type, or prediabetes.

A Feasibility Study to Develop a Diabetes Prevention Program for Young Adults With Prediabetes by Using Digital Platforms and a Handheld Device

Purpose The purpose of this pilot study was to examine the feasibility and preliminary efficacy of an age-specific diabetes prevention program in young adults with prediabetes. Methods A one-group pretest-posttest design was used. The inclusion criteria were age 18 to 29 years and the presence of prediabetes (either impaired fasting glucose of 100-125 mg/dL [5.55-6.94 mmol/L] or A1C of 5.7%-6.4%). Fifteen participants were enrolled in the study. A technology-based lifestyle coaching program focused on diet and physical activity and incorporating a handheld device and digital platforms was developed and tested. Psychosocial factors (health literacy, illness perception, self-efficacy, therapeutic efficacy) based on social cognitive theory, changes in diet and physical activity, and cardiometabolic risk factors were assessed at baseline and week 12 after the intervention. A paired-samples t test was performed to examine changes between baseline and postintervention on each psychosocial and physical variable. Results Participants’ (n = 13 completers) mean age was 24.4 ± 2.2 years, 23.1% were male, and 53.8% were African American. Overall, the participants were satisfied with the intervention (mean score, 4.15 on a 5-point, Likert-type scale). Between pre- and posttesting, mean body mass index and mean A1C decreased from 41.0 ± 7.3 kg/m2 and 6.0 ± 0.5% to 40.1 ± 7.0 kg/m2 and 5.6 ± 0.5%, respectively, whereas mean fasting glucose did not significantly change (from 92.6 ± 11 to 97.6 ± 14.3 mg/dL [5.14 ± 0.61 to 5.42 ± 0.79 mmol/L]). Conclusions The intervention resulted in reduced A1C and a trend toward decreased body mass index in obese sedentary young adults with prediabetes after 12 weeks. Further study through a randomized clinical trial with a longer intervention period is warranted.

Lifestyle habits and obesity progression in overweight and obese American young adults: Lessons for promoting cardiometabolic health

Obesity among young adults is a growing problem in the United States and is related to unhealthy lifestyle habits, such as high caloric intake and inadequate exercise. Accurate assessment of lifestyle habits across obesity stages is important for informing age-specific intervention strategies to prevent and reduce obesity progression. Using a modified version of the Edmonton Obesity Staging System (mEOSS), a new scale for defining obesity risk and predicting obesity morbidity and mortality, this cross-sectional study assessed the prevalence of overweight/obese conditions in 105 young adults and compared their lifestyle habits across the mEOSS stages. Descriptive statistics, chi-square tests, and one-way analyses of variance were performed. Eighty percent of participants (n = 83) fell into the mEOSS-2 group and had obesity-related chronic disorders, such as diabetes, hypertension, and/or dyslipidemia. There were significant differences in dietary quality and patterns across the mEOSS stages. Findings highlighted the significance of prevention and early treatment for overweight and obese young adults to prevent and cease obesity progression.

Prevalence of the metabolic syndrome among overweight and obese college students in Korea.

Objectives:This study examined the prevalence of metabolic risk factors among overweight and obese college students aged 18 to 29 years in Korea. Methods:Baseline data from a healthy lifestyle intervention study for overweight and obese college students in Korea were used. We recruited the sample (N = 73) (84% male; mean [SD] age, 23.77 [2.45] years) from 2 universities in Seoul, Korea, and measured body mass index, waist-hip circumstance, blood pressure, and fasting blood chemistry. Descriptive statistics, Spearman rank order correlations, and analysis of variance were conducted using SPSS 16.0 (SPSS Inc, Chicago, Illinois) for windows. Results:Three-fourths of the participants were identified as being viscerally obese based on the Asia Pacific criteria. Of the total sample, about 12% and 20% were defined as having metabolic syndrome according to the National Cholesterol Education Program-the Adult Treatment Panel III and International Diabetes Federation, respectively. Concordance between the National Cholesterol Education Program-the Adult Treatment Panel III and International Diabetes Federation definitions was very good in the current study (Cohen &kgr; coefficient = 0.74, P <.001). Body mass index was significantly correlated with greater triglyceride and systolic and diastolic blood pressure and waist circumference but with lower high-density lipoprotein cholesterol. Conclusions:Early screening and targeted interventions to prevent obesity and the metabolic syndrome are urgently needed to promote health for adolescents and young adults in South Korea.

Low parent health literacy is associated with ‘obesogenic’ infant care behaviours

Implications for practice and research: Obesogenic infant care behaviours may increase childhood obesity, and predict obesity and related health risks in adulthood. Poor parent health literacy predicts poor child health outcomes including childhood obesity. Nurses should assess parent health literacy and provide appropriate support to prevent obesogenic infant care behaviours. Future research could focus on evaluating parent educational programmes tailored to health literacy level and effectiveness on reducing obesogenic care behaviours.