Kristie J. Lancaster

Barriers to Buying Healthy Foods for People With Diabetes: Evidence of Environmental Disparities

OBJECTIVES A community coalition compared the availability and cost of diabetes-healthy foods in a racial/ethnic minority neighborhood in East Harlem, with those in the adjacent, largely White and affluent Upper East Side in New York City. METHODS We documented which of 173 East Harlem and 152 Upper East Side grocery stores stocked 5 recommended foods. RESULTS Overall, 18% of East Harlem stores stocked recommended foods, compared with 58% of stores in the Upper East Side (P <.0001). Only 9% of East Harlem bodegas (neighborhood stores) carried all items (vs 48% of Upper East Side bodegas), though East Harlem had more bodegas. East Harlem residents were more likely than Upper East Side residents (50% vs 24%) to have stores on their block that did not stock recommended foods and less likely (26% vs 30%) to have stores on their block that stocked recommended foods. CONCLUSIONS A greater effort needs to be made to make available stores that carry diabetes-healthy foods.

Obesity interventions in African American faith-based organizations: a systematic review.

African Americans, especially women, have higher obesity rates than the general US population. Because of the importance of faith to many African Americans, faith‐based organizations (FBOs) may be effective venues for delivering health messages and promoting adoption of healthy behaviours. This article systematically reviews interventions targeting weight and related behaviours in faith settings. We searched literature published through July 2012 for interventions in FBOs targeting weight loss, diet and/or physical activity (PA) in African Americans. Of 27 relevant articles identified, 12 were randomized controlled trials; seven of these reported a statistically significant change in an outcome. Four of the five quasi‐experimental and single‐group design studies reported a statistically significant outcome. All 10 pilot studies reported improvement in at least one outcome, but most did not have a comparison group. Overall, 70% of interventions reported success in reducing weight, 60% reported increased fruit and vegetable intake and 38% reported increased PA. These results suggest that interventions in African American FBOs can successfully improve weight and related behaviours. However, not all of the findings about the success of certain approaches were as expected. This review identifies gaps in knowledge and recommends more rigorous studies be conducted to strengthen the comparative methodology and evidence.

Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association

In 2013, the American Heart Association and American College of Cardiology published the “Guideline on Lifestyle Management to Reduce Cardiovascular Risk,” which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association’s 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015–2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.

Community energy balance: A framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations

INTRODUCTION Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities. METHODS An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity. RESULTS A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts. CONCLUSION The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.

Evaluation of a Nutrition Newsletter by Older Adults

Abstract Newsletters are an increasingly popular way of providing nutrition information. However, there has been little evaluation of their effectiveness as a communication vehicle. This study was conducted to evaluate older adults’ opinions about a nutrition newsletter designed specifically for them and to determine relationships between characteristics of older adults and their opinions. A nationwide sample of men and women aged 55 years and older was asked to answer an initial telephone survey with demographic, health, and nutrition-related questions. They were then asked to receive an issue of a nutrition newsletter written specifically for older adults. If they agreed, they were sent the newsletter, followed by a telephone call that included questions about their opinion of the newsletter relative to its appearance and content, as well as their interest in future nutrition newsletters. One hundred and seventy-two subjects completed all phases of the study. All three newsletter evaluation variables—appearance, interest in content, and interest in future issues—were rated positively by participants.The appearance of the newsletter received the most positive response. The best-fit models accounted for a relatively small percentage of the variation in appearance and content scores. A larger percentage of the variation in interest in future newsletters could be explained by the multivariate model, which found that women and those who were more interested in nutrition and reading were more likely to be interested in future newsletters. The results of this study suggest that a newsletter designed specifically for older adults is an effective way to gain the attention of its intended audience.

An Assessment of Nutrition Education in Selected Counties in New York State Elementary Schools (Kindergarten through Fifth Grade).

OBJECTIVE To assess the extent to which nutrition education is implemented in selected counties in New York State elementary schools (kindergarten through fifth grade) and explore how nutrition knowledge is presented in the classroom and what factors support it. DESIGN Cross-sectional, self-administered survey. SETTING New York State elementary schools in selected counties. PARTICIPANTS New York State elementary school teachers (n = 137). MAIN OUTCOME MEASURES Hours spent teaching nutrition; nutrition topics, methods of teaching, education resources, and aspects of the school environment that may influence nutrition education. ANALYSIS Crosstabs with a chi-square statistic and ANOVA. RESULTS Eighty-three percent of teachers taught some nutrition (9.0 ± 10.5 hours) during the academic year. Teachers taught lessons about finding and choosing healthy food (61%), relationship between diet and health (54%), and MyPyramid (52%) most often. Suburban teachers (12.4 ± 12.5 hours) taught significantly (P = .006) more hours of nutrition than rural teachers (4.2 ± 3.9 hours). Teachers at schools with fewer than 80% nonwhite students taught significantly (P = .02) more (10.4 ± 11.4 hours) compared to schools with greater than 80% nonwhite students (5.6 ± 6.4 hours). CONCLUSIONS AND IMPLICATIONS Teachers reported that nutrition education is important and that they are willing to teach nutrition. Efforts should be made that support integrated nutrition topics, methods of instruction, and availability of resources.

Dehydration in black and white older adults using diuretics.

PURPOSE To assess the association between dehydration and ethnicity in older adults; and to determine if diuretic use can help explain the disparity between blacks and whites in diagnosis of dehydration. METHODS We conducted a case-control study in black and white older adults in a pharmaceutical assistance program who were hospitalized during 1997. Cases were all those diagnosed with dehydration (N=9186). Randomly selected controls were 4:1 frequency matched to cases by sex and age group (N(Total)=45585). RESULTS Patients taking loop, potassium-sparing, thiazide or combination diuretics were more likely to have a diagnosis of dehydration. Dehydration diagnosis was associated with being black (odds ratio (OR)=1.49, 95% confidence interval (CI), 1.36-1.63, p<.001), independent of diuretic use or dosage. That association remained when examining loop (OR=1.36, 95% CI, 1.10-1.63, p<.004) and thiazide diuretic users (OR=1.59, 95% CI, 1.09-2.34, p=.017), but not potassium-sparing or combination diuretic users. CONCLUSION Diuretic use is significantly associated with dehydration diagnosis, but the greater likelihood of older blacks being diagnosed with dehydration is independent of diuretic use. The increased risk of morbidity and mortality associated with dehydration suggests that further examination of the root cause of this disparity in risk is warranted.

Association between self-monitoring of blood glucose and diet among minority patients with diabetes

Background:  Self‐monitoring of blood glucose (SMBG) is used to regulate glucose control. It is unknown whether SMBG can motivate adherence to dietary recommendations. We predicted that participants who used more SMBG would also report lower fat and greater fruit and vegetable consumption.

The FAITh TrIAl: BAselIne ChArACTerIsTICs oF A ChurCh-BAsed TrIAl To Improve Blood pressure ConTrol In BlACks

OBJECTIVE To describe the baseline characteristics of participants in the Faith-based Approaches in the Treatment of Hypertension (FAITH) Trial. DESIGN FAITH evaluates the effectiveness of a faith-based lifestyle intervention vs health education control on blood pressure (BP) reduction among hypertensive Black adults. SETTING PARTICIPANTS AND MAIN MEASURES Participants included 373 members of 32 Black churches in New York City. Baseline data collected included participant demographic characteristics, clinical measures (eg, blood pressure), behaviors (eg, diet, physical activity), and psychosocial factors (eg, self-efficacy, depressive symptoms). RESULTS Participants had a mean age of 63.4 ± 11.9 years and 76% were female. About half completed at least some college (53%), 66% had an income ≥

The challenge of feeding children to protect against overweight

20,000, and 42.2% were retired or on disability. Participants had a mean systolic and diastolic BP of 152.1 ± 16.8 mm Hg and 86.2 ± 12.2 mm Hg, respectively, and a mean BMI of 32 kg/m2. Hypertension (HTN) medications were taken by 95% of participants, but most (79.1%) reported non-adherence to their regimen. Participants reported consuming 3.4 ± 2.6 servings of fruits and vegetables and received 30.9% of their energy from fat. About one-third (35.9%) reported a low activity level. CONCLUSIONS Participants in the FAITH trial exhibited several adverse clinical and behavioral characteristics at baseline. Future analyses will evaluate the effectiveness of the faith-based lifestyle intervention on changes in BP and lifestyle behaviors among hypertensive Black adults.