Helena H. Laroche

Adult Fat Intake Associated with the Presence of Children in Households: Findings from NHANES III

Background: Increasing prevalence of obesity and lifestyle related chronic disease is fundamentally tied to Americans’ poor eating habits. Family environment, including the presence of children, may affect adults’ diet behavior. Objective: To compare dietary fat intake between adults with and without minor children in the home. Design: Secondary analysis of cross-sectional survey data from the National Health and Nutrition Examination Survey III (NHANES III) public use dataset. Subjects: Adults aged 17 to 65 years with and without children younger than 17 years old in the home. Outcome variables: Intake of total fat, saturated fat, and kilocalories based on a 24-hour dietary recall and a selection of high-fat foods from a food frequency questionnaire. Methods: Linear and logistic regression, accounting for the sample weights and complex survey design. Results: The presence of children in the household was associated with significantly higher adjusted total fat consumption for adults (4.9 g/24 hours [95% CI: 0.8, 9.1]) and significantly higher adjusted saturated fat consumption (1.7 g/24 hours [0.3, 3.3]). Adults with children ate many high-fat foods more frequently than adults without children, including salty snacks, pizza, cheese, beef, ice cream, cakes/cookies, bacon/sausage/processed meats, and peanuts. Conclusions: The presence of children in the home may affect adults’ diets. Providers should emphasize dietary discretion for the entire family.

When Adults with Diabetes Attempt to Drink Less Soda : Resulting Adult-Child Interactions and Household Changes

OBJECTIVE To examine adult-child interactions related to soda consumption in families where 1 inner-city African-American or Latino adult with diabetes is attempting lifestyle changes. METHODS The study used semistructured individual interviews of adults and a child (age 10-17) in their home. Interviews were audiotaped, transcribed, coded and analyzed for themes. RESULTS We completed 28 interviews (14 adult-child pairs). Most adults in this group reduced or stopped drinking nondiet soda. Some parents included their children in that change by removing nondiet soda from the household and by delivering messages regarding soda to their children. Some children obtained soda outside the home. Sweetened fruit drinks remained in some households even after nondiet soda was removed. Nonetheless, many children reported adjusting to the lack of soda in the household and a lower intake of nondiet soda and sweetened fruit drinks, in contrast to continued high consumption of sweets and fried food. CONCLUSIONS These in-depth family interviews suggest that interventions intended to change adult consumption of sugar-sweetened beverages may also benefit their children, and this hypothesis merits further investigation in larger studies. A new diabetes diagnosis may motivate adults toward dietary change and provide opportunities to improve overall family health. Healthcare providers should emphasize decreasing availability of soda for everyone in the home.

Marriage and parenthood in relation to obesogenic neighborhood trajectories: The CARDIA study

Marriage and parenthood are associated with weight gain and residential mobility. Little is known about how obesity-relevant environmental contexts differ according to family structure. We estimated trajectories of neighborhood poverty, population density, and density of fast food restaurants, supermarkets, and commercial and public physical activity facilities for adults from a biracial cohort (CARDIA, n=4,174, aged 25-50) over 13 years (1992-93 through 2005-06) using latent growth curve analysis. We estimated associations of marriage, parenthood, and race with the observed neighborhood trajectories. Married participants tended to live in neighborhoods with lower poverty, population density, and availability of all types of food and physical activity amenities. Parenthood was similarly but less consistently related to neighborhood characteristics. Marriage and parenthood were more strongly related to neighborhood trajectories in whites (versus blacks), who, in prior studies, exhibit weaker associations between neighborhood characteristics and health. Greater understanding of how interactive family and neighborhood environments contribute to healthy living is needed.

Extending Work on Rural Health Disparities: A Commentary on Matthews and Colleagues’ Report

We are writing The Journal of Rural Health to draw readers’ attention to the recent study by Matthews and colleagues that appeared in Morbidity and Mortality Weekly Report and offer suggestions to extend their work. We applaud the authors for their focus on rural health—a disparities dimension that is often overlooked—and concur with their assessment that US health surveillance data are rarely disaggregated by meaningful geographic location. Indeed, the authors’ use of 6 detailed geographic categorizations is a marked advance over the commonly used urbanrural dichotomy. Further, Matthews and associates examined 4 health-related behaviors (smoking, physical activity, alcohol consumption, and amount of sleep) and 1 key health status (overweight) that are not only antecedent to multiple health outcomes, but are also the targets of several Healthy People 2020 objectives. In short, their report provides better data about the geographic distribution of key determinants, which is a necessary foundation for efforts to improve population health generally and to address rural health disparities specifically. We reiterate Matthew and colleagues’ key findings. Compared to metropolitan counties (ie, urban, suburban, and periurban), noncore (ie, rural) counties had higher levels of current smoking, excessive drinking, and overweight, but lower levels of physical activity. There was no difference by geographic area in prevalence of adequate sleep, which fell short of target levels in all geographic areas. Approximately one-third of rural county residents reported multiple health risks, with higher levels of multiple risks among rural women, people age 65 and older, and those with higher educational attainment. Although the study’s focus was largely on the distribution of healthrisk behaviors, Matthews and colleagues also noted the role of social context in shaping rural health. In the interest of developing a more rigorous evidence base, particularly one that fosters a holistic understanding of rural health risks, we offer several recommendations to build upon Matthews and colleagues’ work. First, we note that at present, no Healthy People 2020 objectives focus specifically on rural health, and we recognize that many current objectives would benefit from consideration of geographic variation. For example, it is well documented that nonmetropolitan areas suffer from constrained economic opportunity leading to higher levels of poverty, a key social determinant of health. Thus, objective SDOH-3.2, which seeks to monitor the proportion of children living in poverty, would benefit from analysis by geographic unit, such as the 6-level categorization used by Matthews and associates. We encourage the development of new rural health objectives as well as

Healthy Concessions: High School Students' Responses to Healthy Concession Stand Changes

BACKGROUND A previous sales data analysis demonstrated success in selling healthier items at a concession stand. Questions remained regarding student satisfaction and whether the intervention reached non-health-conscious students. METHODS Cross-sectional anonymous samples of students at a large midwestern high school were surveyed before and after an intervention improved the number of healthier items available at the concession stand. RESULTS The survey was completed by 301 students preintervention and 314 students postintervention. Satisfaction remained good (3.7 preintervention and 3.6 postintervention). Satisfaction with the variety and taste of foods increased. We compared students who felt having healthy items were important at the concessions to those who did not. Overall satisfaction with concessions did not differ between groups. The latter group (healthy items not important) reported improved satisfaction with food variety (2.8 to 3.1, p = .02) and the former reported improved satisfaction with healthy foods (2.5 to 2.9, p = .03) and overall taste (3.2 to 3.4, p = .02). Of the healthy items not important students 76% reported purchasing at least 1 new healthier food. CONCLUSIONS Adding healthier foods to school concession stands has positive effects on student satisfaction, sales, and reaches all students whether or not they care about having healthy items available.

Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes:

In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community

Background: Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods: The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results: We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions: This study will assess the effectiveness and impact of a community-wide intervention to support physical activity.

Calibration of the global physical activity questionnaire to Accelerometry measured physical activity and sedentary behavior

BackgroundSelf-report questionnaires are a valuable method of physical activity measurement in public health research; however, accuracy is often lacking. The purpose of this study is to improve the validity of the Global Physical Activity Questionnaire by calibrating it to 7 days of accelerometer measured physical activity and sedentary behavior.MethodsParticipants (n = 108) wore an ActiGraph GT9X Link on their non-dominant wrist for 7 days. Following the accelerometer wear period, participants completed a telephone Global Physical Activity Questionnaire with a research assistant. Data were split into training and testing samples, and multivariable linear regression models built using functions of the GPAQ self-report data to predict ActiGraph measured physical activity and sedentary behavior. Models were evaluated with the testing sample and an independent validation sample (n = 120) using Mean Squared Prediction Errors.ResultsThe prediction models utilized sedentary behavior, and moderate- and vigorous-intensity physical activity self-reported scores from the questionnaire, and participant age. Transformations of each variable, as well as break point analysis were considered. Prediction errors were reduced by 77.7–80.6% for sedentary behavior and 61.3–98.6% for physical activity by using the multivariable linear regression models over raw questionnaire scores.ConclusionsThis research demonstrates the utility of calibrating self-report questionnaire data to objective measures to improve estimates of physical activity and sedentary behavior. It provides an understanding of the divide between objective and subjective measures, and provides a means to utilize the two methods as a unified measure.