Karina Christiansen

Healthier Home Food Preparation Methods and Youth and Caregiver Psychosocial Factors Are Associated with Lower BMI in African American Youth

Obesity disproportionately affects African American (AA) children and adolescents and leads to an increased risk of adult chronic diseases. Eating few meals at home has been implicated as a cause of obesity among youth, but to our knowledge, previous studies have not specifically investigated this relationship in AA adolescents or looked at both the healthfulness and frequency of home meals in AA households. The objective of the present study was to investigate the relationship between home food preparation and adolescent BMI in a sample of 240 AA adolescents aged 10-15 y and their caregivers. Multiple linear regressions were used to model psychosocial characteristics, household factors, and adolescent and caregiver food preparation behaviors as predictors of adolescent BMI, and psychosocial and household factors as predictors of food preparation behavior. Adolescents in the sample had a mean BMI-for-age percentile of 70.4, and >90% of the sample families received at least one form of food assistance. Adolescent children of caregivers who used healthier cooking methods were more likely to use healthy cooking methods themselves (P = 0.02). Having more meals prepared by a caregiver was predictive of higher BMI-for-age percentile in adolescents (P = 0.02), but healthier cooking methods used by the caregiver was associated with reduced risk of adolescent overweight or obesity (P < 0.01). Meals prepared at home in AA households do not necessarily promote healthy BMI in youth. Family meals are a promising adolescent obesity prevention strategy, but it is important to target both frequency and healthfulness of meals prepared at home for effective health promotion in AA families.

Food Expenditures and Food Purchasing Among Low-Income, Urban, African-American Youth

BACKGROUND Low-income, urban African-American youth are at higher risk for obesity and less likely to meet dietary recommendations than white, higher-income youth. Patterns of food purchasing among youth likely contribute to these disparities, but little published information is available. PURPOSE To investigate food purchasing behaviors of low-income, urban African-American youth. METHODS A total of 242 African-American youth, aged 10-14 years, were recruited from 14 recreation centers in low-income, predominantly African-American neighborhoods in Baltimore MD. Youth reported the amount of money typically spent on food, the source of this money, the place of purchase, and frequency of purchase for 29 foods and beverages. Data were collected in 2008-2009 and analyzed in 2009-2010. RESULTS Youth reported spending an average of

Development and implementation of Baltimore Healthy Eating Zones: A youth-targeted intervention to improve the urban food environment

3.96 on foods and beverages in a typical day. Corner stores were the most frequently visited food source (youth made purchases at these stores an average of 2.0 times per week). Chips, candy, and soda were the most commonly purchased items, with youth purchasing these an average of 2.5, 1.8, and 1.4 times per week, respectively. Older age was associated with more money spent on food in a typical day (p<0.01). CONCLUSIONS Food purchasing among low-income, urban African-American youth is frequent and substantial. Interventions aimed at preventing and treating obesity in this population should focus on increasing access to healthy foods in their neighborhoods, especially in corner stores.

Environmental factors that impact the eating behaviors of low-income African American adolescents in Baltimore City.

Poor accessibility to affordable healthy foods is associated with higher rates of obesity and diet-related chronic diseases. We present our process evaluation of a youth-targeted environmental intervention (Baltimore Healthy Eating Zones) that aimed to increase the availability of healthy foods and promote these foods through signage, taste tests and other interactive activities in low-income Baltimore City. Trained peer educators reinforced program messages. Dose, fidelity and reach-as measured by food stocking, posting of print materials, distribution of giveaways and number of interactions with community members-were collected in six recreation centers and 21 nearby corner stores and carryouts. Participating stores stocked promoted foods and promotional print materials with moderate fidelity. Interactive sessions were implemented with high reach and dose among both adults and youth aged 10-14 years, with more than 4000 interactions. Recreation centers appear to be a promising location to interact with low-income youth and reinforce exposure to messages.

Healthy food purchasing among African American youth: associations with child gender, adult caregiver characteristics and the home food environment

OBJECTIVE To understand environmental factors influencing the food-related habits of low-income urban African American adolescents. DESIGN Qualitative research was conducted between February and April, 2010, using in-depth interviews, focus groups, and direct observation. SETTING The study was conducted in low-income, predominantly African American neighborhoods of Baltimore City. PARTICIPANTS A total of 20 adolescents were interviewed in 18 in-depth interviews (n = 13) and 2 focus groups (n = 7). Participants were recruited from Baltimore City recreation centers and were eligible if they were African American and aged 10-16 years. PHENOMENON OF INTEREST The food-related habits of low-income, African American, urban adolescents and reported perceptions of their food environments. ANALYSIS Interviews were audio recorded, transcribed, coded, and analyzed for emerging themes. RESULTS Six thematic categories emerged and were organized into 4 environmental contexts: the neighborhood context (accessibility of food and safety of neighborhood), the school context (school food environment), the family context (family health history, role modeling, and monitoring) and the peer context (peer behaviors). CONCLUSIONS AND IMPLICATIONS Future efforts to reduce the obesity epidemic among low-income African American adolescents should address the social environment of the family; however, positive behavior change may not be sustainable without neighborhood or school food environment modifications.

“Cause it’s family talking to you”: Children acting as change agents for adult food and physical activity behaviors in American Indian households in the Upper Midwestern United States

OBJECTIVE To examine how factors related to the home food environment and individual characteristics are associated with healthy food purchasing among low-income African American (AA) youth. SUBJECTS A total of 206 AA youth (ninety-one boys and 115 girls), aged 10-14 years, and their primary adult caregivers. SETTING Fourteen Baltimore recreation centres in low-income neighbourhoods. DESIGN Cross-sectional study. We collected information about food purchasing, the home food environment, sociodemographic and psychosocial factors drawn from social cognitive theory. Multivariable logistic regression was used to examine the factors associated with the frequency and proportion of healthy food purchases in all youth and stratified by gender. Low-fat or low-sugar foods were defined as healthy. RESULTS Youth purchased an average of 1.5 healthy foods (range=0-15) in the week before the interview, comprising an average of 11.6% (range=0-80%) of total food purchases. The most commonly purchased healthy foods included water and sunflower seeds/nuts. Healthier food-related behavioural intentions were associated with a higher frequency of healthy foods purchased (OR=1.4, P<0.05), which was stronger in girls (OR=1.9, P<0.01). Greater caregiver self-efficacy for healthy food purchasing/preparation was associated with increased frequency of healthy purchasing among girls (OR=1.3, P<0.05). Among girls, more frequent food preparation by a family member (OR=6.6, P<0.01) was associated with purchasing a higher proportion of healthy foods. No significant associations were observed for boys. CONCLUSIONS Interventions focused on AA girls should emphasize increasing food-related behavioural intentions. For girls, associations between caregiver self-efficacy and home food preparation suggest the importance of the caregiver in healthy food purchasing.

Food and Nutrient Intake in African American Children and Adolescents Aged 5 to 16 Years in Baltimore City.

This article presents research findings from the formative phase of OPREVENT, a pilot obesity prevention intervention trial for American Indian households on two reservations in the Upper Midwestern United States. We describe processes by which American Indian children acting as change agents influence adult food and physical activity behaviors on an Ojibwa and a Potawatomi reservation. This study borrows from Bronfenbrenner and Ceci’s socio-ecological model and extends Daniel’s resiliency theory for practice with vulnerable children. Using purposive sampling, we interviewed 168 community members, including 25 children between 6 and 13 years of age, using adult in-depth and paired-child interviews, household group interviews, focus groups, and community workshops. Results reveal that six American Indian children, 10–13 years old, were acting as change agents. We propose a socio-ecological conceptual framework to guide our understanding and application of a children as change agent approach for adult health behaviors which includes cultural identity (macro-system), institutional and community support (mezzo-system), family support through a secure base (micro-system), and children’s sense of belonging, self-esteem, self-efficacy, knowledge, and actions as change agents (intrapersonal factors). Resiliency and vulnerability are dynamic processes that intersect the multiple systems throughout children’s developmental stages to bolster their agency. We conclude with considerations for the OPREVENT pilot project and discuss future directions for developing a child as change agent theoretical framework for adult health behavior change.

“We’re Changing Our Ways”: Women’s Coping Strategies for Obesity Risk-reducing Behaviors in American Indian Households

Objective: This study aimed to describe food and nutrient intake for low-income, urban African American children and adolescents, to highlight the need for further nutrition intervention programs and appropriate tools to address overweight and obesity. Methods: This was a cross-sectional study using interviewer-administered single 24-hour dietary recalls. Participants were low-income African American boys and girls aged 5–16 years or their caregivers in Baltimore City. Frequency of food consumption and dietary intakes were analyzed by gender and age groups. Results: Eighty-one participants were included for analysis. Mean daily energy intakes exceeded Dietary Reference Intakes (DRIs) from 10% to 71% across all gender-age groups: 2304 kcal for children aged 5–8 years; 2429 kcal and 2732 kcal for boys and girls aged 9–13 years, respectively; and 3339 kcal and 2846 kcal for boys and girls aged 14–16 years, respectively. The most frequently reported consumed foods were sweetened drinks, chips, candies, and milk across all age groups. The majority of participants (79–100%) did not meet the DRIs for dietary fiber and vitamin E across all gender-age groups. Milk accounted for 14%, 17%, and 21% of energy, fat, and protein intake, respectively, among children 5–8 years of age, while pizza was the top source of energy, fat, and protein (11%, 13%, and 18%, respectively) among 14-to 16-year-old adolescents. Sweetened drinks and sweetened juices were major sources of sugar, contributing 33% for 5–8 year olds, 29% for 9–13 year olds, and 35% for 14–16 year olds. Conclusions: Mean daily energy intake exceeded dietary recommendations across all gender-age groups. This study has provided previously unavailable information on diet and highlights foods to be targeted in nutrition intervention programs.

Self-Reported Physical Activity Among American Indian Adults From Two Diverse Regions

This article reveals women caregivers’ perceptions and coping strategies to improve households’ food and physical activity habits. Results emerged from the pre-intervention formative research phase of a multi-site, multi-level obesity prevention pilot intervention on American Indian (AI) reservations. Using purposive sampling, 250 adults and children participated in qualitative research. Results reveal that having local institutional support was a key structural facilitator. ‘Family connectedness’ emerged as a key relational facilitator. Hegemony of systems, food deserts, transportation, and weather were key structural barriers; Childcare needs and time constraints were key relational barriers. Women’s coping strategies included planning ahead, maximizing, apportioning, tempting healthy, and social support. Findings informed the development and implementation of a novel obesity prevention pilot intervention tailored for each participating AI community addressing culturally relevant messages, institutional policies, and programs. We conclude with future consideration for comparative, ethnicity-based, class-based, and gender-specific studies on women’s coping strategies for household health behaviors.

Work, worksites, and wellbeing among North American Indian women: a qualitative study

PURPOSE Physical activity may be a protective factor against the disproportionate rates of chronic diseases faced by American Indians. Nevertheless, few studies report any cultural adoptions made to capture physical activity behaviors among this hard-to-reach population. Existing studies reporting the prevalence of physical activity among American Indians are often aggregated and tend to obscure regional, local, and tribal-level variations. This study examines the prevalence of physical activity and inactivity levels, along with associated factors, among rural dwelling American Indian adults from 2 distinct regions. METHODS Baseline self-reported data were collected using a culturally modified version of the International Physical Activity Questionnaire (IPAQ) short form during the Obesity Research Prevention and Evaluation of Intervention Effectiveness in Native North Americans trial (OPREVENT) among rural American Indian adults (aged 18-75 years) from 5 tribal communities in Michigan and New Mexico. FINDINGS Most participants were classified as moderately physically active (43.5%), and the majority reported access to physical activity facilities (83.5%). Michigan participants reported engaging in more moderate and total physical activity than those in New Mexico (P < .001) and reported spending less time sitting (P < .001). CONCLUSIONS Differences in physical activity among the American Indian communities may be due to regional variations in occupations, climate, and tribal and community support and infrastructure. The unexpected high level of activity evokes uncertainty in the accuracy and appropriateness of the data collection instrument. Research is needed to understand culturally appropriate approaches to measure physical activity and inactivity among rural American Indians.