Jean C. Norris

Improving diet and physical activity with ALIVE: a worksite randomized trial.

CONTEXT Healthy diets and regular physical activity confer many health benefits, but the prevalence of these behaviors is relatively low. BACKGROUND Cost-effective strategies are needed to increase healthy eating and physical activity in the population. DESIGN An RCT, conducted in 2006, of a 16-week e-mail program offered individually tailored, small-step goals; a personal homepage with tips; educational materials; and tracking and simulation tools. SETTING/POPULATION Seven hundred eighty-seven employees in the administrative offices of a large healthcare organization volunteered to participate. MAIN OUTCOME MEASURES Changes were self-reported for total physical activity; moderate physical activity (MPA); vigorous physical activity (VPA); walking; sedentary behavior; and intake of fruits and vegetables, saturated and trans fats, and added sugars in the intervention group compared to the control group. RESULTS In intent-to-treat analyses (conducted in 2007 and 2008) that set change in nonresponders to the follow-up questionnaire to zero, the intervention group reported increases of 28.0 minutes/week (min/wk) of MPA (SE=7.4, p=0.0002); 12.5 min/wk of VPA (SE=5.7, p=0.03); and 21.5 min/wk of walking (SE=5.5, p=0.0003) relative to the control group. Intake of both saturated and trans fats (grams/day [g/day]) declined (beta=-0.95, SE=0.36, p=0.01; beta=-0.29, SE=0.12, p=0.02, respectively). The consumption of fruits and vegetables increased significantly (p=0.03), and the consumption of added sugars decreased marginally (p=0.08). The largest changes were in participants who did not meet behavioral recommendations at baseline (increase of 55.4 min/wk of MPA and decrease of 1.15 g/day of trans fats, relative to the control group). Differences between the intervention and control groups were still observed 4 months after the intervention ended. CONCLUSIONS ALIVE is an effective program for achieving significant improvement in diet and physical activity. TRIAL REGISTRATION NCT00607009.

Sources of Energy and Six Nutrients in Diets of Low-Income Hispanic-American Women and their Children: Quantitative Data from HHANES, 1982-1984

OBJECTIVE Identification of important food sources of energy, protein, fat, vitamin A, vitamin C, calcium, and iron for low-income Hispanic women and their children. DESIGN A subset of 24-hour recalls from the Hispanic Health and Nutrition Examination Survey (HHANES), a sample representing 76% of the Hispanic-origin population, provides the most comprehensive examination of Hispanic food habits in the United States. SUBJECTS/SAMPLES The sample, which approximates the population of the Special Supplemental Food Program for Women, Infants, and Children (WIC), included 1,046 17- to 34-year-old women with household income less than 185% of poverty level and their 1- to 5-year-old children (n = 1,063). MAIN OUTCOME MEASURES Tables show the percentage that each food contributes to total intake of energy and six nutrients for women and for children and percentage of persons who reported consuming each food during a 24-hour period. RESULTS Cultural foods contributed less to the energy and nutrient intake of the population than expected, with few exceptions, notably beans, rice, tortillas, and salsa. Major sources of energy and nutrients were similar to those seen for blacks and whites in the second National Health and Nutrition Examination Survey (1976-1980). APPLICATIONS The data presented should be useful to researchers designing dietary assessment instruments and to nutrition educators designing or adapting educational materials. The data may be of particular interest to WIC staff who work with low-income Hispanic populations.

US trends in nutrient intake: the 1987 and 1992 National Health Interview Surveys.

OBJECTIVES This study examined US trends in nutrient intake, using almost identical methods and nutrient databases in two time periods. METHODS An extensive dietary intake questionnaire was included in supplements to the 1987 and 1992 National Health Interview Surveys. Dietary data from approximately 11,000 persons in each of those years were analyzed. RESULTS The total and saturated fat intake and the percentage of energy from fat declined among Whites and Hispanics, but only minimal changes were seen in Black Americans. The changes in fat intake were attributable principally to behavioral changes in frequency and type of fat-containing foods consumed rather than to the increased availability of leaner cuts of meat. Dietary cholesterol showed one of the largest declines of the nutrients examined. Less desirable changes were also seen. Cereal fortification played an important role in the observed changes in several micronutrients. CONCLUSIONS Educational campaigns on dietary fat and cholesterol have been moderately effective, but not in all racial/ethnic groups. Future campaigns should emphasize maintaining or increasing micronutrient intake.

Homelessness, Hunger and Material Hardship among Those Who Lost SSI

The nine-city SSI Stud) followed 1,764 randomly sampled recipients of Supplemental Security Income (SSI) benefits for Drug Addiction and Alcoholism (DA&A) for two years after program termination in January 1997. About one-third of respondents requalified for SSI benefits, and about half of those who lost benefits replaced 50% or more of their baseline income with public assistance, wages, or help from family or friends. We examined the effects of loss of benefits and income replacement on six hardship indicators. Material hardship rates were high even at baseline. Over the follow-up period, hardships were 60%–70% more likely among those who lost SSI benefits and were unable to replace half of baseline income. Alcohol, drug, social, and legal problems also increased the odds of housing and food-related hardships. Physical and mental health problems increased hunger but not housing problems. Those who did not replace half their income were 10 times more likely than those who retained SSI to double-up in housing during the follow-up.

SSI Receipt and Alcohol and Other Drug use among Former SSI DA&A Beneficiaries

Following termination of the SSI Drug Addiction and Alcoholism (DA&A) program, a nine-site study followed 1,764 randomly selected SSI beneficiaries over two years. This paper examines how loss of SSI affected use of alcohol and illegal drugs. One-third of study respondents reported neither drinking nor using illegal drugs at baseline (just before the end of the program). Nevertheless, use of illegal drugs was 15 times more prevalent among the study sample (44%) than the general population, while use of alcohol was 1.3 times more prevalent (59%), and use of both alcohol and other drugs was significantly greater among those who would lose SSI than those who would retain it. During the follow-up period, prevalence of drinking and use of illegal drugs remained steady, but mean days of use declined for alcohol and illegal drugs other than marijuana. In three separate repeated measures ordinal regression models we examined the net effect of SSI retention on use of alcohol, marijuana and other illegal drugs over time, controlling for demographics, social and health status, and utilization of substance abuse treatment or self-help. Declines in use of alcohol and illegal drugs other than marijuana were similar for those who retained and those who lost SSI benefits, indicating that termination of the program had no effect on levels of substance use. Higher levels of substance use remained significantly and substantially associated with younger age (under 44 years), psychiatric and legal problems, and family or social conflicts, suggesting that subsets of the DA&A population need individualized services beyond income support.

Development of an updated phytoestrogen database for use with the SWAN food frequency questionnaire: intakes and food sources in a community-based, multiethnic cohort study.

Phytoestrogens, heterocyclic phenols found in plants, may benefit several health outcomes. However, epidemiologic studies of the health effects of dietary phytoestrogens have yielded mixed results, in part due to challenges inherent in estimating dietary intakes. The goal of this study was to improve the estimates of dietary phytoestrogen consumption using a modified Block Food Frequency Questionnaire (FFQ), a 137-item FFQ created for the Study of Womens Health Across the Nation (SWAN) in 1994. To expand the database of sources from which phytonutrient intakes were computed, we conducted a comprehensive PubMed/Medline search covering January 1994 through September 2008. The expanded database included 4 isoflavones, coumestrol, and 4 lignans. The new database estimated isoflavone content of 105 food items (76.6%) vs. 14 (10.2%) in the 1994 version and computed coumestrol content of 52 food items (38.0%), compared to 1 (0.7%) in the original version. Newly added were lignans; values for 104 FFQ food items (75.9%) were calculated. In addition, we report here the phytonutrient intakes for each racial and language group in the SWAN sample and present major food sources from which the phytonutrients came. This enhanced ascertainment of phytoestrogens will permit improved studies of their health effects.

Gender-Specific Barriers to Self-Sufficiency Among Former Supplemental Security Income Drug Addiction and Alcoholism Beneficiaries: Implications for Welfare-To-Work Programs and Services

ABSTRACT This study examines barriers to economic self-sufficiency among a panel of 219 former Supplemental Security Income (SSI) drug addiction and alcoholism (DA&A) recipients following elimination of DA&A as an eligibility category for SSI disability benefits. Study participants were comprehensively surveyed at six measurement points following the policy change. Generalized estimating equations were used to examine full-sample and gender-specific barriers to economic self-sufficiency. Results indicate that access to transportation, age, and time are the strongest predictors of achieving self-sufficiency for both men and women leaving the welfare system. Gender-specific barriers are also identified. Future research needs to assess the generalizability of these results to other public assistance recipients.

The Effects of Eliminating Supplemental Security Income Drug Addiction and Alcoholism Eligibility on the Mental Health of Low-Income Substance Abusers

On January 1, 1997, as the result of federal legislation, many low-income substance abusers lost income and healthcare benefits provided by the Supplemental Security Income (SSI) program. This study examined the effects of eliminating drug addiction and alcoholism (DAA) as qualifying impairments for SSI benefits on the mental health and mental health treatment utilization of former beneficiaries 3.5 years following the policy change. Study participants in four Northern California counties were categorized into three comparison groups based on their primary income source over the lifetime of the study. Findings indicated that overall the reported mental health status of former SSI DAA beneficiaries improved following the policy change; however, study participants who relied primarily on some other type of public assistance post-termination reported an increase in mental health treatment utilization.

Relative validation of a short questionnaire to assess the dietary habits of pregnant American Indian women

Abstract The objective of this study was to compare a short dietary screener developed to assess diet quality with interviewer‐administered telephone 24‐hour dietary recalls in a population of pregnant Northern Plains (NP) American Indian women. Participants were recruited from NP clinical sites of the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network, as part of a large, prospective, multidisciplinary study. Prenatal PASS participants who enrolled prior to 24 weeks gestation were eligible to participate. Repeated 24‐hour dietary recalls were collected using the Nutrition Data System for Research (NDSR) software and a short dietary screener was administered intended to capture usual dietary intake during pregnancy. The available recalls were averaged across days for analysis. Items were grouped from the recalls to match the food group data estimates for the screener (e.g., total vegetables, total fruit, total dairy, total and whole grains). Deattenuated Pearson correlation coefficients were calculated between the two data sources after correcting for the within‐person variation in the 24‐hour recall data. A total of 164 eligible women completed the screener and at least two 24‐hour dietary recalls and were included in the analyses. Pearson deattenuated correlation coefficients between the diet screener and the dietary recalls for the majority of food groups were 0.40 or higher. This short diet screener to assess usual diet appears to be a valid instrument for use in evaluating diet quality among pregnant American Indian women.