L. Franzen-Castle

Investigating dietary acculturation and intake among US-born and Thailand/Laos-born Hmong-American children aged 9-18 years

OBJECTIVE The Hmong are a growing population of South-East Asian immigrants with increasing rates of obesity and diabetes, yet little is known about their dietary consumption patterns. The present study aimed to investigate the dietary intake of Hmong children and whether acculturation and/or time lived in the USA influences dietary intake, BMI and nutritional status. DESIGN Two 24 h dietary recalls were collected on non-consecutive days using the multiple-pass interviewing method and were averaged. Heights and weights were measured, from which BMI was calculated. An acculturation score was computed. SETTING Schools, churches, Hmong organizations, and community centres. SUBJECTS Three hundred and thirty-five Hmong children aged 9-18 years from Twin Cities, Minnesota, USA. RESULTS Approximately half of our participants were either overweight or obese. US-born children were significantly heavier, taller, had a higher BMI, and in general consumed more energy, saturated fat and Na than those who were born in Thailand/Laos and were living in the USA for <5 years. Children who were more acculturated to US norms including language use, social connections and dietary habits had higher BMI-for-age and consumed significantly more saturated fat, trans fatty acids, Na and Ca compared with their less acculturated counterparts. CONCLUSIONS Diets of most Hmong children appear below the recommendations for fibre, vitamins A, D and E, Ca, P, Mg and K, and are higher in fats, sugars and Na. Living in an obesogenic US environment is a probable reason for poor dietary quality of Hmong and may be a contributing factor to the rising rates of obesity and diabetes in this population.

Dietary acculturation and body composition predict American Mmong children's blood pressure

Determine how dietary acculturation, anthropometric measures (height, weight, circumferences, and skinfolds), body mass index (BMI), and waist hip ratios (WHRs) are associated with blood pressure (BP) measures in Hmong children living in Minnesota.

Food-related behavior and intake of adult main meal preparers of 9–10 year-old children participating in iCook 4-H: A five-state childhood obesity prevention pilot study

It is important to understand adult outcomes in childhood obesity prevention programs as parents and caregivers have a significant influence on the eating and physical activity habits of youth. Grounded in the social cognitive theory, the iCook 4-H study was centered on a dyad model (9-10 year-olds and their primary meal preparers) to teach healthy cooking skills, shopping and meal habits, and being active as a family. The program took place in five states and dyads (n = 54) were recruited through flyers, e-mails, and in-person contact. The focus of this article is to provide findings from adult program participants. Demographics and self-reported food intake, procurement, preparation and safety practices, feeding relationships, mealtime routines, and height and weight were collected through surveys at baseline and program completion, which spanned 3 months. Descriptive statistics including two-related samples tests and paired samples t tests were used to assess pre- and post-program survey data responses at p < 0.05 significance level. Most had a bachelors degree (31%) or some college (29%), about half were white, 66% were married, about 30% of households participated in assistance programs, and 82% were female. At program conclusion, participants significantly improved meal planning, prioritizing healthy meal choices, shopping with a grocery list, and reading Nutrition Facts Labels. There were also significant, positive differences noted in cooking skill confidence (p = 0.015), desire to cook more meals at home, and fewer fast food meals. Adult-youth feeding interactions also significantly improved. There were also significant increases in fruit juice (100%), vegetable soup, and whole grain consumption. Based on results, adults reported improvements in meal planning, cooking, and purchasing skills that were taught in classes.

Development and validation of the Full Restaurant Evaluation Supporting a Healthy (FRESH) Dining Environment Audit

ABSTRACT The Full Restaurant Evaluation Supporting a Healthy (FRESH) Dining Environment Audit was developed and validated to assess cafeterias and restaurants (n = 362). Each scale item was scored using a 5-point semantic-differential rating (1 = little/no options/support to 5 = extensive options/high support for healthy food selection). Statistical analysis included factor analysis, analysis of variance, and correlations. The Healthfulness of Foods (HF) sub-scale assessed menu descriptions to determine healthful foods availability (12 items, α = .82, possible = 60). The Dining Environmental Supports (ES) sub-scale assessed nutrition information/labeling, signage/posters, and portion/cup sizes (eight items, α = .78; possible = 40). Cafeterias consistently scored higher than other restaurant types on HF (29.45 ± 12.17 SD) and ES (22.10 ± 5.27 SD). Convergent validity was confirmed (n = 91; HF: r = .854, p ≤ .001 and ES: r = .529, p ≤ .01). The FRESH audit is a simple tool that effectively assessed differences in the healthfulness of foods and environmental supports between a variety of dining venues.

Assessment of Physical Activity in 9- to 10-Year-Old Children Participating in a Family-Centered Intervention

Physical activity (PA) was assessed via accelerometers in 48 children who participated in a pilot obesity prevention intervention. Differences between pre- and postmean minutes of sedentary time and PA including light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) were compared by paired t test (P ≤ 0.05). No significant differences were found (respective mean minutes ± standard deviation; P value): sedentary time (522 ± 46, 525 ± 49; P = 0.69), LPA (263 ± 32, 254 ± 37; P = 0.17), MPA (37 ± 12, 38 ± 12; P = 0.41), VPA (18 ± 11, 23 ± 14; P = 0.17), and MVPA (55 ± 19, 61 ± 23; P = 0.15). These findings prompted PA curriculum revisions, although PA did not significantly increase, 37% at preintervention and 47% at postintervention met PA guidelines.

An Impact Mapping Method to Generate Robust Qualitative Evaluation of Community-Based Research Programs for Youth and Adults

Ripple Effect Mapping (REM) is an evaluation approach that has traditionally been used in community settings to visually map the impact of programming and community interventions. This manuscript utilizes the Community Capitals Framework (CCF) to inform REM and to better highlight the changes and impact between various levels of a community, following a childhood obesity prevention intervention. The addition of in-depth qualitative analyses makes this approach particularly useful for the evaluation of interventions with a research–community partnership focus. The objective of this study was to describe a CCF-informed REM approach with detailed protocol, training, and application to the community-based, childhood obesity prevention intervention, iCook 4-H, which targeted youth and adult pairs. This protocol includes the steps required to prepare for REM sessions of, ideally, six youth and adult pairs, one facilitator, and one or two evaluators/note takers. REM sessions typically begin with an icebreaker and appreciative inquiry activities that inform the REM mapping process that follows. In-depth qualitative analysis of the notes and map images captured during REM sessions ensure the rigor required for research-related interventions. Researchers, community members, and participants can use CCF-informed REM collectively as a robust evaluation tool to demonstrate, through visual mapping, the positive effects of community-partnered research programs.

Ripple Effect Mapping Outcomes of a Childhood Obesity Prevention Program From Youth and Adult Dyads Using a Qualitative Approach: iCook 4-H

Objective: To describe the impact of the iCook 4‐H intervention study based on data gathered through ripple effect mapping focus groups through an explorative approach. Design: Youth–adult dyads responded about ways in which iCook had affected the individual, family, and community. Three questions were asked: (1) What were people doing differently as a result of iCook? (2) Who benefited from iCook and how? (3) Were there changes in the way community groups and institutions did things as a result of iCook? Setting: Ripple effect mapping sessions took place across 5 states (Maine, Nebraska, South Dakota, Tennessee, and West Virginia). Participants: Seventy dyad participants (n = 35 youth, n = 35 adults) from the iCook 4‐H intervention. Main Outcome Measure: Three core themes of iCook 4‐H were assessed: cooking, eating, and playing together. Analysis: Direct content analysis and word frequencies were used. Results: Seven categories emerged: improved health, increased community involvement, increased knowledge, increased communication, changed motivation, financial mindfulness, and increased appreciation for family. An overarching theme that was determined was that learning new skills together through trying new things (cooking, eating, and playing) leads to positive individual family and community change. Conclusions and Implications: Ripple effect mapping was effective in determining the perceived impact of iCook 4‐H on oneself, family, and community.

Daily Dietary Intake Patterns Improve after Visiting a Food Pantry among Food-Insecure Rural Midwestern Adults

Emergency food pantries provide food at no cost to low-resource populations. The purpose of this study was to evaluate single-day dietary intake patterns before and after visiting a food pantry among food-secure and food-insecure pantry clients. This observational cohort study comprised a paired, before-and-after design with a pantry visit as the intervention. Participants (n = 455) completed a demographic and food security assessment, and two 24-h dietary recalls. Adult food security was measured using the U.S. Household Food Security Survey Module. Dietary intake patterns were assessed using Automated Self-Administered 24-h Recall data and classified by Healthy Eating Index (HEI-2010) scores, dietary variety, number of eating occasions, and energy intake. Paired t-tests and Wilcoxon signed-rank tests compared outcomes before and after a pantry visit. Mean dietary variety increased after the pantry visit among both food-secure (p = 0.02) and food-insecure (p < 0.0001) pantry clients. Mean energy intake (p = 0.0003), number of eating occasions (p = 0.004), and HEI-2010 component scores for total fruit (p < 0.001) and whole fruit (p < 0.0003) increased among food-insecure pantry clients only. A pantry visit may improve dietary intake patterns, especially among food-insecure pantry clients.

Quality of Life Associated with Physical Activity but not Sedentary Time in Youth

Purpose: It has been reported that youth who engaged in more screen time had lower quality of life scores compared to those that were more physically active. Furthermore, increased sedentary behavior increases health risks particularly the risk for obesity. A cross-sectional analysis was completed to examine the relationship between healthrelated quality-of-life (HRQOL) and accelerometer-measured sedentary time (ST) and physical activity (PA) in 9-10-yearold youth who were recruited for the family-based, childhood obesity intervention, iCook 4-H. It was hypothesized that objectively measured ST would be negatively correlated and PA would be positively correlated with HRQOL. Methods: A subset of participants (n=118) wore Actigraph GT3X+ accelerometers for 7 days and completed the Pediatric Quality of Life survey (PedsQLTM, version 4.0) to assess HRQOL. Mean daily minutes of accelerometermeasured ST (547 ± 60) and PA including light-intensity (LPA=240 ± 49), moderate-intensity (MPA=35 ± 11), vigorous-intensity (VPA=17 ± 9), and moderate-to vigorousintensity (MVPA=52 ± 19) were evaluated during waking hours. Multiple linear regressions were used to assess relationship between ST and PA intensities with HRQOL. Statistical significance was set at p ≤ 0.05. Results: There were no significant associations between ST or LPA with HRQOL. MPA, VPA and MVPA were positively associated with multiple HRQOL domains. Conclusion: The lack of relationship between objectively measured ST and LPA with the total HRQOL score and subscales merits further investigation. The findings of the current study support the need for lifestyle interventions that engage families in behavior that increases MVPA.

Prevalence and Predictors of Household Food Insecurity among Adult/Youth Dyads at the Initiation of the iCook 4-H Two-Year Obesity Prevention Study

Objective: Determine food insecurity prevalence and predictors among adult/youth dyads enrolled in a childhood obesity prevention study (iCook 4-H). Methods: The iCook 4-H intervention was designed for youth (9-10 years old) and their adult main meals preparer to cook, eat, and play together. Although not an inclusion criteria, diverse, low income, and/or rural families were the target during recruitment. At baseline, adults completed surveys on food insecurity, socioeconomic and demographic characteristics and youth anthropometrics were collected with body mass index (BMI) calculated. Descriptive statistics were computed and chi-square analysis was conducted to test differences between potential predictors and food insecurity. Binomial logistic regression was used to assess the relationship between food insecurity and its predictors. Results: Thirty-four percent of households (n=71 of 206) were food insecure. Youth were primarily white (69.9%) and normal weight (58.3%). Adults were also primarily white (74.8%), overweight or obese (67.9%), married (68.9%), not participating in government assistance programs (57.8%), and held no college degree (55.3%). Based on the logistic regression model, households with a non-white youth (OR=13.53; 95% CI=3.33, 55.05), an adult without a college degree (OR=5.62; 95% CI=2.01, 15.73), and government assistance program participation (OR=5.63; 95% CI=2.63, 12.07) were significantly associated with household food insecurity. However, there was no significant association with BMI found (youth p=0.167; adult p=0.179). Conclusion: Consistent with previous findings, household food insecurity status was associated with youth race, adult education, and government assistance program participation. In contrast, no relationship between BMI and food insecurity status was observed in this study, which warrants further investigation.