Mary Murimi

From Controlled Trial to Community Adoption: The Multisite Translational Community Trial

Methods for translating the findings of controlled trials, such as the Diabetes Prevention Program, into real-world community application have not been clearly defined. A standardized research methodology for making and evaluating such a transition is needed. We introduce the multisite translational community trial (mTCT) as the research analog to the multisite randomized controlled trial. The mTCT is adapted to incorporate the principles and practices of community-based participatory research and the increased relevance and generalizability gained from diverse community settings. The mTCT is a tool designed to bridge the gap between what a clinical trial demonstrates can work in principle and what is needed to make it workable and effective in real-world settings. Its utility could be put to the test, in particular with practice-based research networks such as the Prevention Research Centers.

Practicing Preventive Health: The Underlying Culture among Low-Income Rural Populations.

CONTEXT Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. PURPOSE The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. METHODS Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. FINDINGS Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. CONCLUSIONS The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.

Factors that Influence Breastfeeding Decisions among Special Supplemental Nutrition Program for Women, Infants, and Children Participants from Central Louisiana

Although human milk provides optimal nutrition for infants, fewer than one third of US infants are breastfed exclusively for 6 months or more. The objectives of this study were to determine the factors that have the greatest impact on the decisions to breastfeed, and to determine the effect of formula provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on the initiation and duration of breastfeeding among WIC participants in a rural parish in central Louisiana. A cross-sectional study was done between September 2007 and March 2008 among 130 WIC participants. Approximately half (51%) of the participants reported breastfeeding their youngest child for a mean of 15.7+/-14.9 weeks, with more white mothers breastfeeding than did African-American mothers or other races (P<0.01). Significantly more people reported that incentives provided to encourage breastfeeding did not affect their decision to breastfeed than those who said incentives affected their decision to breastfeed (P<0.029). Finally, study participants who were breastfed as a child were significantly more likely to breastfeed their children than those who were not breastfed as a child (P<0.022). The majority (96%) of the participants in this study indicated that WIC is providing effective and clear education about the benefits of breastfeeding, and that this advice influenced their decision to breastfeed their children. These findings underscore the importance of emphasizing the health benefits of breastfeeding to increase initiation and duration rates among WIC participants.

Exploring Effectiveness of Messaging in Childhood Obesity Campaigns

David Katz: This discussion will focus on controversial campaigns for bringing the issue of obesity, and in particular childhood obesity, to the attention of the public, to raise awareness of the problem and, presumably, provoke constructive responses. There have been various reactions to such campaigns and some have been fairly emotionally charged, ranging from it being a good thing to bring attention to childhood overweight and obesity to expressions of strong offense. We are, therefore, seeking ground rules to guide these efforts in the future, based on the fundamental principles that would make a public service campaign about childhood obesity objectionable or unacceptable.

Multiple Point-of-Testing Nutrition Counseling Sessions Reduce Risk Factors for Chronic Disease Among Older Adults

The objectives of this study were to explore the relationships of baseline dietary intakes and frequency of attendance at point-of-testing nutrition counseling sessions to selected risk factors for chronic diseases during a 3-year intervention. This study was part of a large multidisciplinary, community-based health outreach project conducted in a rural community of northern Louisiana. Screenings, point-of-testing counseling, weekly group exercise sessions, and group nutrition education sessions were provided over a period of 3 years. Outcome variables assessed at 6-month intervals over 3 years were body mass index (BMI), systolic and diastolic blood pressure, fasting blood glucose, and total and LDL cholesterol and dietary intake. Repeated measure analysis of variance was used to investigate the impact of the frequency of counseling sessions on outcome variables. Paired t-tests were used to identify points at which significant changes occurred. A total of 159 subjects ages 65 years and older participated in this study. The majority of the participants were female (62%) and White (82%). Attending the point of testing counseling for more than two sessions was important for a significant improvement in BMI (p ≤ 0.001), LDL cholesterol (p ≤ 0.03), blood glucose (p ≤ 0.03), and diastolic blood pressure (p ≤ 0.045). Participants who attended at least three sessions had significant reductions in risk factors for obesity and related chronic diseases, underscoring the importance of follow-up sessions after health screening.

Effects of school-based point-of- testing counselling on health status variables among rural adolescents

Objective: Rural areas may suffer from a lack of access to health care and programmes to promote behaviours such as healthy eating and physical activity. Point-of-testing counselling is a method of promoting a healthy lifestyle during an individual’s most ‘teachable moment’. Design/Setting: This longitudinal study examined the effects of school-based nutrition education and point-of-testing counselling on nutrition knowledge, weight, blood lipid profile and blood pressure over a 3-year period (2005–2008) among junior high and high school students from a rural community in the Southern USA. Methods: Screening for health variables, followed by point-of-testing counselling sessions, was offered every 6 months, along with nutrition education once a week for 12 weeks. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS). T-tests and analysis of variance (ANOVA) were conducted to analyse changes in health outcomes over the course of the study. Results: A total of 233 rural students participated in this longitudinal community-based study. Students who attended at least four sessions (n = 52) were analysed for changes in health outcomes. High-density lipoprotein levels significantly increased between the second and fourth visits. Attending the intervention at least four times stabilised or improved blood values and anthropometric measurements. Significant nutrition knowledge increases were documented among 7th and 8th graders; 6th, 9th and 10th graders also showed modest improvements. Conclusion: Using point-of-testing counselling may be an effective strategy in delaying or preventing the onset of risk factors for obesity and related chronic diseases during adolescence.

Fostering Healthy Lifestyles in the African American Population

Approximately 8.3% of the U.S. population (25.8 million people) is affected by type 2 diabetes. The burden of diabetes is disproportionately greater in the African American community. Compared with non-Hispanic Caucasian adults, the risk of diagnosed type 2 diabetes was 77% higher among non-Hispanic Blacks, who are 27% more likely to die of diabetes complications than either Caucasians or Hispanics. The purpose of this longitudinal community intervention was to promote healthy lifestyles among African American participants through multiple channels, including individualized point-of-testing counseling, and weekly exercise and nutrition classes led by trained community health mentors. Data collection procedures were guided by the World Health Organization’s STEPS approach, which includes gathering demographic and health information, collecting anthropometric measurements, and analyzing biochemical blood work. Changes in body mass index were assessed from in-person measurements and changes in blood lipids and glucose were examined by biochemical analyses. A total of 157 individuals participated in this study. Results showed that weight gain during the intervention was prevented, glucose levels decreased (−10.88 mg/dL), and low-density lipoprotein cholesterol decreased (−8.8 mg/dL), while high-density lipoprotein increased (+3.2 mg/dL). Lifestyle interventions and point-of-testing counseling can be successful in reducing risk factors for type 2 diabetes among the African American population. The results of this intervention indicate that the use of community health mentors and point-of-testing counseling may be effective in fostering healthy lifestyle changes, which can halt the progression of type 2 diabetes among non-Hispanic Black populations.

Factors that Influence the Efficacy of Nutrition Education Interventions Among Adults: A Systematic Review

healthy diet as well as foods that should be consumed in moderation. There is a need for HFE assessments that adequately capture a wide spectrum of foods. Objective: To gain insight into foods that families are serving in the home and to modify the Home Inventory Describing Eating and Activity (Home-IDEA) checklist, a validated instrument for HFE assessment. Study Design, Setting, Participants, Intervention: Photographs from seven consecutive dinnertime meals lowincome families (n = 29) in rural Colorado were used to identify present foods. Outcomes Measures and Analysis: Foods on the HomeIDEA checklist were dichotomously categorized as healthful (foods that meet the Dietary Guidelines for Americans, i.e. fruits, vegetables, and whole grains) or less healthful (foods high in sodium and solid fats and added sugars, i.e. chips, candy, and soda). Dinnertime photos were qualitatively analyzed to produce a list of foods available in the home environment. This was then compared with the HomeIDEA checklist. Results: Of 108 foods in the Home-IDEA, 68% (n = 73) represented healthful foods. With the remaining 32% (n = 35) representing less healthful foods. Data analyzed from the photos found 55 foods that were not captured by the Home-IDEA, a majority of which could be considered less healthful, i.e. canned soup, fried taco shells, and prepackaged baked goods. Conclusions and Implications: In its current state, the Home-IDEA is weighted toward capturing nutrient-rich foods in the HFE. Increased representation of less healthful foods will improve the assessment of HFE quality. HFE assessment tools are strengthened by using a variety of approaches to identify foods for inclusion like meal photography, diet records, or national databases in addition to encompassing dietary guideline recommendations. A mixed methods approach has the potential to yield more comprehensive tools for assessing the quality of the HFE. Funding: NIFA.

Effective nutrition education and communication for sustainable maternal and child health

Maternal and child health (MCH) consists of an interdependent reproductive system that collectively determines the survival of the mother during childbirth, and determines the health and survival of the child. This interdependency underscores the importance of appropriate and timely interventions during pregnancy through the first 1000 d at the minimum. The Millennium Development Goals (MDG) recommended the use of the continuum of care for the development of interventions by addressing all the stages of MCH. The purpose of the present paper is to review the factors that contributed to the attainment of the MDG 4 and MDG 5 by analysing the interventions conducted by the countries that achieved at least 5·0 and 5·5 %, respectively, and determine the level of their intervention based on the MCH conceptual framework. Out of the eighteen selected countries discussed, fifteen countries achieved their target for either MDG 4 or MDG 5 or both, while three countries did not achieve their target. The countries that were more likely to achieve their targets addressed the societal, underlying and direct causes, and implemented country wide policies. In contrast, the countries that did not succeed were more likely to address the direct causes with poor policy implementation. Understanding the motivation and limitations of the target population, including nutrition education and targeting behaviour change has the potential to result in sustainable MCH. This information has the potential to enlighten the policymakers as we progress to the sustainable development goals, specifically goals 2 and 3.

Targeting Influencers of Behavior in Nutrition Education

The mission of the Society for Nutrition Education and Behavior (SNEB) is to promote effective nutrition education andhealthybehavior through research, policy, and practice. Members of SNEB are engaged as researchers, professors, and industry professionals, as well as with governmental agencies. Our target population includes people from every stage of the lifecycle ranging from pregnancy to the elderly. This wide area of practice affords an extensive range of influence. This editorial will discuss ways of maximizing our impact by targeting the influencers of desireddietary behaviors. Recently, I took a self-assessment on factors that influencemydietarybehaviors and the wide array of influencers was surprising. This list included memories, experiences, people, expectations, fears, geographical locations, and many others.As inmycase, persistentbehaviors have a myriad of influencers that may include modifiable factors such as awareness, knowledge, and skills. However, influencersmay also include unmodifiable factors such as poverty, gender, educational level, age, culture, and geographical location that collectively influence behaviors. The purpose of this editorial is to challenge the current approaches to nutrition education forbehavior change. The art and science of influencing healthful behavior has been complicated by the demand for immediate gratification by consumers. Healthy consumers are looking for immediate and quick solutions with minimal effort on their part. Immediate gratification syndromefocusesonthedesiredoutcome with little or no consideration for the behavior change process or the duration needed to sustainably achieve the preferred outcome. On the other hand, a well-designed health promotion intervention that produces sustainable and positive changes require time, effort, and a deep understanding of the underlying and direct influencers. With the understanding that it is not always possible to address all the factors, it is critical to identify and address the influencers with the highest leverage in achieving thedesiredoutcomes.Nutrition educators should be careful not to cave in to the immediate gratification syndrome in an effort to provide quick solutionswhile designinghealth related messages for complex issues. It is, therefore, crucial that as we strive to influence others in adapting healthy lifestyles,we lookatwhat influences the desired behaviors and systematically address those influencers. At the individual level, motivation and ability are important influencers of behavior changeaccording to Fogg’s behaviormodel.However, it is important to remember that in addition to the individual influencers, the community and societal factors are important influencers of behavior. For example, a study targeting preschool children was able to achieve its objectives by purposefully including key influencers, such as teachers, coaches, cartooncharacters, andvideoswithchildren and parents, as part of the intervention. Similarly, nutrition educators in the community were more likely to be successful when they addressed the environmental, cognitive, and cultural factors after identifying them as critical influencers to behavior change. Given the complexity of behavior change, confounded by the fact that healthful behaviors could be unaffordable or uncomfortable, and that unhealthy choices could be pleasurable and appealing, it is critical for nutrition educators aimingat behavior change to engage every source of influence available, and where possible, to engage the influencers that have the greatest impact tomake healthful behavior sustainable. The collective training and experience that SNEB members have acquired in nutrition education positions the organization as a leader and influencer of healthy behavior through research, policy, and practice.