Katherine Alaimo

Dietary methods research in the third National Health and Nutrition Examination Survey: underreporting of energy intake.

Assessment of diet is a critical component of the third National Health and Nutrition Examination Survey (NHANES III), which was designed to describe the health and nutritional status of the US population. We analyzed data collected with the primary dietary assessment instrument used in NHANES III, the 24-h recall, for 7769 nonpregnant adults aged > or = 20 y to investigate underreporting of total energy intake. Underreporting was addressed by computing a ratio of energy intake (EI) to estimated basal metabolic rate (BMRest). EI:BMRest was 1.47 for men and 1.26 for nonpregnant women; a population level of 1.55 is expected for a sedentary population. About 18% of the men and 28% of the women were classified as underreporters. Underreporting of energy intake was highest in women and persons who were older, overweight, or trying to lose weight. Underreporting varied according to smoking status, level of education, physical activity, and the day of the week the 24-h recall covered. Additionally, underreporting was associated with diets lower in fat (P < 0.01) and alcohol (P < 0.01 in women) when expressed as a percentage of total energy intake.

Fruit and Vegetable Intake among Urban Community Gardeners

OBJECTIVE To determine the association between household participation in a community garden and fruit and vegetable consumption among urban adults. DESIGN Data were analyzed from a cross-sectional random phone survey conducted in 2003. A quota sampling strategy was used to ensure that all census tracts within the city were represented. SETTING Flint, Michigan. PARTICIPANTS 766 adults. VARIABLES MEASURED Fruit and vegetable intake was measured using questionnaire items from the Behavioral Risk Factor Surveillance System. Household participation in a community garden was assessed by asking the respondent if he or she, or any member of the household, had participated in a community garden project in the last year. ANALYSIS Generalized linear models and logistic regression models assessed the association between household participation in a community garden and fruit and vegetable intake, controlling for demographic, neighborhood participation, and health variables. RESULTS Adults with a household member who participated in a community garden consumed fruits and vegetables 1.4 more times per day than those who did not participate, and they were 3.5 times more likely to consume fruits and vegetables at least 5 times daily. CONCLUSIONS AND IMPLICATIONS Household participation in a community garden may improve fruit and vegetable intake among urban adults.

Total energy intake of the US population: the third National Health and Nutrition Examination Survey, 1988-1991.

The third National Health and Nutrition Examination Survey (NHANES III) was conducted to assess the health and nutritional status of the US population. As part of the nutritional status assessment, reliable 24-h dietary recalls were collected for 14,801 examined persons. Mean (+/- SEM) energy intakes are reported for persons aged > or = 2 mo by age, sex, and race-ethnicity. Males had higher mean energy intakes than did females. Energy intakes peaked during late adolescence and young adulthood and declined thereafter. Energy intake patterns were similar among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Underreporting was addressed by computing a ratio of energy intake (EI) to estimated basal metabolic rate (BMRest). This ratio (EI:BMRest) was 1.47 for adult males and 1.26 for nonpregnant adult females. Overweight adults had a lower mean EI:BMRest (1.09 in females and 1.28 in males). Underreporting in food consumption surveys remains problematic among females and overweight persons.

Importance of Cognitive Testing for Survey Items: An Example From Food Security Questionnaires

Abstract Cognitive testing is a useful tool for the development of questionnaire items and can also provide valuable information for the analysis and/or interpretation of preexisting survey data. This paper explains cognitive testing methods and demonstrates the benefits of cognitive testing on existing hunger, food insecurity, and food insufficiency questionnaire items. Semistructured interviews were conducted using retrospective verbal probing techniques. Each interview consisted of two parts: (1) the respondent answered a series of hunger and food insecurity items successively and (2) the interviewer engaged the respondent in a conversation that explored the meaning of the questionnaire items and the respondents answers to the items. Selected results are described to illustrate how the assessment of questionnaire items is facilitated by cognitive testing. Among other benefits, cognitive testing can clarify the meaning of specific words, determine the best item form and response categories, and help determine question meaning after a survey has been fielded. These results demonstrate that cognitive testing can be beneficial when assessing the quality of questionnaire items and determining item meaning.

Growing Vegetables and Values: Benefits of Neighborhood-Based Community Gardens for Youth Development and Nutrition

ABSTRACT Community gardens are one way that residents have mobilized to beautify urban neighborhoods, improve access to fresh produce, and engage youth. Qualitative case studies were conducted of two neighborhood-based community gardens with youth programs. Data collection included participant observation and in-depth interviews with adult gardeners and neighbors, youth, and community police officers. Results suggest that the garden programs provided opportunities for constructive activities, contributions to the community, relationship and interpersonal skill development, informal social control, exploring cognitive and behavioral competence, and improved nutrition. Community gardens promoted developmental assets for involved youth while improving their access to and consumption of healthy foods.

Facilitators to Promoting Health in Schools: Is School Health Climate the Key?.

BACKGROUND Schools can promote healthy eating in adolescents. This study used a qualitative approach to examine barriers and facilitators to healthy eating in schools. METHODS Case studies were conducted with 8 low-income Michigan middle schools. Interviews were conducted with 1 administrator, the food service director, and 1 member of the coordinated school health team at each school. RESULTS Barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods. Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements. CONCLUSIONS The set of key characteristics identified in successful schools may represent a schools health climate. While models of school climate have been utilized in the educational field in relation to academic outcomes, a health-specific model of school climate would be useful in guiding school health practitioners and researchers and may improve the effectiveness of interventions aimed at improving student dietary intake and other health behaviors.

Assessment of a healthy corner store program (FIT Store) in low-income, urban, and ethnically diverse neighborhoods in Michigan.

This study evaluated a community-based and social marketing healthy corner store program (FIT store) to improve the affordability and availability of healthy foods in low-income, urban, and ethnically diverse neighborhoods in Michigan. The Nutrition Environment Measures Survey in Stores data were analyzed for the FIT (N = 4) stores. Two cross-sectional surveys were conducted among the FIT store customers before (N = 401) and after (N = 318) the intervention. Three FIT stores improved their total Nutrition Environment Measures Survey in Stores availability score from before to after the intervention. A significantly higher level of FIT awareness and monthly bean and nut consumption was reported in the postintervention.

Amplifying Health Through Community Gardens: A Framework for Advancing Multicomponent, Behaviorally Based Neighborhood Interventions

The article presents a framework for understanding the relationship between community garden participation, and the myriad ways gardens and participation lead to emotional, social, and health impacts. Existing empirical research relating community gardens to health behaviors, such as physical activity and diet, and longer-term chronic disease-related outcomes is summarized. The research areas discussed include the effects of community garden participation on individual, social, emotional, and environmental processes; health behaviors including diet and physical activity; and health outcomes such as self-rated health, obesity, and mental health. Other mechanisms through which community gardens may affect population health are described. Applying a multitheoretical lens to explore associations between community garden participation and health enables us to delineate key aspects of gardening that elicit positive health behaviors and multifactorial health assets that could be applied to designing other types of health interventions.

Junk food consumption and screen time: association with childhood adiposity.

OBJECTIVES To determine the joint association of junk food consumption (JFC) and screen time (ST) with adiposity in children. METHODS Two hundred fourteen (121 girls, 93 boys) third-to-fifth-grade students (54% Hispanic, 35% African American, 8% white) completed a lifestyle behavior survey, which included self-reported JFC and ST, as part of a school-based lifestyle intervention program. RESULTS Neither JFC nor ST, independently or jointly, was associated with adiposity measures. JFC and ST were significantly correlated (r = .375). CONCLUSIONS The low achievement of physical activity and screen time recommendations and high prevalence of overweight/obesity in this mostly minority, low socioeconomic status population indicates a potential focus for intervention.

The Michigan Healthy School Action Tools Process Generates Improvements in School Nutrition Policies and Practices, and Student Dietary Intake

The Michigan Healthy School Action Tools (HSAT) is an online self-assessment and action planning process for schools seeking to improve their health policies and practices. The School Nutrition Advances Kids study, a 2-year quasi-experimental intervention with low-income middle schools, evaluated whether completing the HSAT with a facilitator assistance and small grant funding resulted in (1) improvements in school nutrition practices and policies and (2) improvements in student dietary intake. A total of 65 low-income Michigan middle schools participated in the study. The Block Youth Food Frequency Questionnaire was completed by 1,176 seventh-grade students at baseline and in eighth grade (during intervention). Schools reported nutrition-related policies and practices/education using the School Environment and Policy Survey. Schools completing the HSAT were compared to schools that did not complete the HSAT with regard to number of policy and practice changes and student dietary intake. Schools that completed the HSAT made significantly more nutrition practice/education changes than schools that did not complete the HSAT, and students in those schools made dietary improvements in fruit, fiber, and cholesterol intake. The Michigan HSAT process is an effective strategy to initiate improvements in nutrition policies and practices within schools, and to improve student dietary intake.