Marilyn S. Nanney

Prevention of overweight and obesity in children: influences on the food environment.

PURPOSE There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in youth. The purpose of this review is to describe the multiple paths of influence on the food environment of youth and to identify diabetes education strategies focused on early prevention of overweight and obesity. METHODS A review of relevant professional literature was conducted. RESULTS Models of obesity prevention in youth need to address genetic factors that influence the development of food preferences in the young child, parenting influences on eating pattern development, and access and availability of foods in the physical environment of the child. CONCLUSIONS Early intervention with parents of young children is required to prevent the development of eating patterns that lead to pediatric obesity and type 2 diabetes in youth. Diabetes educators need to be able to inform parents of the multiple paths of influence on the food environment of the child and suggest strategies to encourage the development of positive food preferences and intake.

Improving dietary behavior in African Americans: the Parents As Teachers High 5, Low Fat Program

BACKGROUND The High 5, Low Fat Program (H5LF) for African American parents was developed in partnership with the Parents As Teachers program, and was designed to test a dietary intervention appropriate for national adoption. METHODS H5LF used a group randomized, nested cohort design with 738 parents. Consistent with organizational goals and methods, parent educators delivered a dietary change program via personal visits, newsletters, and group meetings. Primary outcomes were reducing percentage calories from fat and increasing fruit and vegetable consumption among participating parents; intermediate aims included improving in nutrition-related skills and parental modeling of dietary behaviors. RESULTS H5LF parents achieved a 0.53 increase in fruit and vegetable consumption (P = 0.03), and a higher proportion of H5LF parents reduced their intake to less than 30% calories from fat (chi(2) = 4.8, P < 0.03; -1.7% calories from fat, p = 0.07) and improved performance of dietary behaviors (F = 14.2, P = 0.004). Improvements in parental modeling were not statistically significant. CONCLUSIONS H5LF is an effective intervention that is appropriate for national adoption by over 2000 Parents As Teachers sites with the potential to impact dietary intake of African American parents nationwide.

Evaluating changeability to improve fruit and vegetable intake among school aged children

BackgroundThe purposes of this paper are two fold. First, to describe an approach used to identify fruits and vegetables to target for a child focused dietary change intervention. Second, to evaluate the concept of fruit and vegetable changeability and feasibility of applying it in a community setting.MethodsSteps for identifying changeable fruits and vegetables include (1) identifying a dietary database (2) defining geographic and (3) personal demographics that characterize the food environment and (4) determining which fruits and vegetables are likely to improve during an intervention. The validity of these methods are evaluated for credibility using data collected from quasi-experimental, controlled design among 7–9 year old children (n = 304) participating in a tutoring or mentoring program in St. Louis, MO. Using a 28-item food frequency questionnaire, parents were asked to recall for their child how often foods were eaten the past 7 days. This questionnaire was repeated eight months later (response rate 84%). T-test analyses are used to determine mean serving differences from baseline to post test.ResultsThe mean serving differences from baseline to post test were significant for moderately eaten fruits (p < .001), however, not for vegetables (p = .312). Among the intervention group, significantly more children ate grapes (p < .001), peaches (p = .022), cantaloupe (p < .001), and spinach (p = .044) at post testing – all identified as changeable with information tailored to participants.ConclusionData driven, food focused interventions directed at a priority population are feasible and practical. An empirical evaluation of the assumptions associated with these methods supports this novel approach. However, results may indicate that these methods may be more relevant to fruits than vegetables. This process can be applied to diverse populations for many dietary outcomes. Intervention strategies that target only those changeable fruits and vegetables are innovative and warrant further study.

A community research partnership to improve the diet of African Americans.

OBJECTIVE To describe a community research partnership in which a national parent education organization collaborated with academic institutions to develop a dietary change program for underserved African American parents. METHODS Qualitative methods were used to characterize issues that impacted partnership operations. RESULTS Data are reported on partnership activities including program development and implementation with African American parents. Lessons learned and strategies for improving the partnership are presented. CONCLUSIONS Ongoing assessment and evaluation of how a partnership operates, especially in the context of multiple sites, are important to sustaining successful functioning.

Examination of the Adherence to the “5 a Day the Color Way” Campaign Among Parents and Their Preschool Children

Background. The evidence of health benefits associated with the consumption of a variety fruits and vegetables (FV) is well known. The “5 A Day Color Way” campaign is a national effort to translate the science with a message of increased colorful FV consumption for the public. The extent of the translation and adherence to these recommendations among families in a community setting is an important public health question.Methods. Parents enrolled in 8 rural Missouri county parent education programs answered surveys for their preschool children (n=1658) about FV consumption and barriers to purchasing them by color.Results. Of parents, 40% (n=668) and 26% (n=425) of children ate from all 5 colors some time the previous week. However, no parents and only 1 child attained perfect adherence to the guidelines (all 5 colors most days of the week). Disliking the taste and not in the habit of purchasing colorful FV were significant predictors for not meeting recommendations for red, yellow/orange, and green FV.Conclusions. Interventions targeting young children and their families (ie, child care settings, elementary schools) that establish preference for color specific FV may be ideal in rural communities to encourage movement toward adherence to the campaign.

Organizational capacity's effects on the delivery and outcomes of health education programs.

Community-based public health efforts to change health behaviors and health outcomes generally involve the implementation of complex, multipronged programs, which utilize many resources, both inside and outside a single community-based organization or agency. It is becoming more apparent that the organizational capacities of these agencies influence the implementation and success of health promotion programs. However, research is limited on the specific organizational capacities (e.g., resources, training, workload, trust, communication) that influence program implementation and, thus, the ultimate impact of these programs. This article seeks to address this gap in the literature by identifying organizational capacity variables that may have influenced the delivery of a dietary change program.

Stage of Readiness and Role Modeling of Dietary Patterns to Children by African American Parents

Abstract The dietary patterns and intake of preschool children are impacted by their parents. The importance of parental modeling of positive nutrition behaviors to their children is a principle of the High 5, Low Fat Study, a quasi-experimental, nested cohort study involving 1440 African American adults implemented through a national parent education program. We hypothesized that parents who are in action stages (action and maintenance) for engaging in low fat eating patterns will model positive nutrition behaviors to their children more frequently than those in preaction stages (precontemplators, contemplators, preparation stages). Baseline telephone interviews conducted with 457 African American parents (99% female; ages 18 – 65) included two measures: Stage of Readiness to Change 6 Low Fat Dietary Patterns and the Parental Modeling Measure of frequency with which parents report engaging in positive dietary behaviors for their children (alpha = 0.82). Parents reported being in preaction stages of readiness to: use low fat dairy products (82%), low fat condiments (77%), avoid fat as flavoring (76%), bake instead of fry foods (52%), eat lean cuts of meat (56%), and eat 5 servings of fruits and vegetables (60%). Preaction parents role modeled the following patterns to their children significantly less frequently (p